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How to Structure the Table of Contents for a Research Paper

How to Structure the Table of Contents for a Research Paper

4-minute read

  • 16th July 2023

So you’ve made it to the important step of writing the table of contents for your paper. Congratulations on making it this far! Whether you’re writing a research paper or a dissertation , the table of contents not only provides the reader with guidance on where to find the sections of your paper, but it also signals that a quality piece of research is to follow. Here, we will provide detailed instructions on how to structure the table of contents for your research paper.

Steps to Create a Table of Contents

  • Insert the table of contents after the title page.

Within the structure of your research paper , you should place the table of contents after the title page but before the introduction or the beginning of the content. If your research paper includes an abstract or an acknowledgements section , place the table of contents after it.

  • List all the paper’s sections and subsections in chronological order.

Depending on the complexity of your paper, this list will include chapters (first-level headings), chapter sections (second-level headings), and perhaps subsections (third-level headings). If you have a chapter outline , it will come in handy during this step. You should include the bibliography and all appendices in your table of contents. If you have more than a few charts and figures (more often the case in a dissertation than in a research paper), you should add them to a separate list of charts and figures that immediately follows the table of contents. (Check out our FAQs below for additional guidance on items that should not be in your table of contents.)

  • Paginate each section.

Label each section and subsection with the page number it begins on. Be sure to do a check after you’ve made your final edits to ensure that you don’t need to update the page numbers.

  • Format your table of contents.

The way you format your table of contents will depend on the style guide you use for the rest of your paper. For example, there are table of contents formatting guidelines for Turabian/Chicago and MLA styles, and although the APA recommends checking with your instructor for formatting instructions (always a good rule of thumb), you can also create a table of contents for a research paper that follows APA style .

  • Add hyperlinks if you like.

Depending on the word processing software you’re using, you may also be able to hyperlink the sections of your table of contents for easier navigation through your paper. (Instructions for this feature are available for both Microsoft Word and Google Docs .)

To summarize, the following steps will help you create a clear and concise table of contents to guide readers through your research paper:

1. Insert the table of contents after the title page.

2. List all the sections and subsections in chronological order.

3. Paginate each section.

4. Format the table of contents according to your style guide.

5. Add optional hyperlinks.

If you’d like help formatting and proofreading your research paper , check out some of our services. You can even submit a sample for free . Best of luck writing your research paper table of contents!

What is a table of contents?

A table of contents is a listing of each section of a document in chronological order, accompanied by the page number where the section begins. A table of contents gives the reader an overview of the contents of a document, as well as providing guidance on where to find each section.

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What should I include in my table of contents?

If your paper contains any of the following sections, they should be included in your table of contents:

●  Chapters, chapter sections, and subsections

●  Introduction

●  Conclusion

●  Appendices

●  Bibliography

Although recommendations may differ among institutions, you generally should not include the following in your table of contents:

●  Title page

●  Abstract

●  Acknowledgements

●  Forward or preface

If you have several charts, figures, or tables, consider creating a separate list for them that will immediately follow the table of contents. Also, you don’t need to include the table of contents itself in your table of contents.

Is there more than one way to format a table of contents?

Yes! In addition to following any recommendations from your instructor or institution, you should follow the stipulations of your style guide .

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Home » APA Table of Contents – Format and Example

APA Table of Contents – Format and Example

Table of Contents

APA Table of Contents

APA Table of Contents

The APA (American Psychological Association) Table of Contents is a structured outline that provides an overview of the content of a research paper or manuscript. It is typically included in the front matter of the document and lists the major sections and subsections of the paper, along with their page numbers. The Table of Contents is an important organizational tool that helps readers navigate the document and locate specific information quickly and easily.

How to Make APA Table of Contents

Here are the steps you can follow:

  • Create a new page for the table of contents. The page number should be the Roman numeral “i”.
  • Center the title “Table of Contents” at the top of the page.
  • List all the headings and subheadings in your paper in order. Be sure to include all major sections and subsections.
  • Align the page numbers to the right margin of the page.
  • Use dot leaders to connect the headings to their respective page numbers. Dot leaders are a row of dots that help guide the reader’s eye from the heading to the page number.

I. Introduction ……………………………………………………… i

II. Literature Review ……………………………………………….. 1

A. Subheading ………………………………………………………… 2

B. Subheading ………………………………………………………… 3

III. Methodology ………………………………………………………….. 4

A. Participants ………………………………………………………… 5

B. Procedure …………………………………………………………… 6

IV. Results ……………………………………………………………………. 8

V. Discussion ……………………………………………………………… 10

VI. Conclusion …………………………………………………………….. 12

How to Make APA Table of Contents in MS Words

To create an APA table of contents in Microsoft Word, follow these steps:

  • Start by typing out your document in Microsoft Word.
  • Once you have finished typing your document, place your cursor at the beginning of your document.
  • Click on the “References” tab in the top menu bar.
  • Click on the “Table of Contents” option on the left-hand side of the menu bar.
  • Choose one of the APA table of contents styles from the drop-down menu that appears. There are two options for an APA table of contents: “APA 6th Edition” and “APA 7th Edition.”
  • Once you have chosen your preferred APA table of contents style, click on it to insert it into your document.
  • Now you need to format your headings to be included in the table of contents. Select the heading you want to include in your table of contents.
  • Click on the “Styles” option in the top menu bar.
  • Choose the appropriate heading style from the drop-down menu that appears. You can choose from “Heading 1,” “Heading 2,” “Heading 3,” etc.
  • Repeat the previous two steps for each heading you want to include in the table of contents.
  • Once you have formatted all the headings, go back to the “References” tab in the top menu bar.
  • Select the “Update Table” option from the drop-down menu that appears.
  • Choose whether you want to update the page numbers only or the entire table of contents.
  • Click “OK” to update your table of contents.

Your APA table of contents is now complete!

APA Table of Contents Format

Here’s the general format for creating a table of contents in APA style:

  • Start a new page after the title page and abstract.
  • Type “Table of Contents” at the top of the page, centered.
  • List all the major sections of your paper, including the introduction, body, and conclusion.
  • Indent each level of subheading, using either the tab key or your word processor’s formatting tools.
  • Use the same font and size for the table of contents as you did for the rest of the paper.
  • Align page numbers on the right side of the page, directly after each section and sub-section.
  • Include any appendices and references in the table of contents, if applicable.

Here is an example of an APA-formatted table of contents:

Table of Contents Format

Introduction ………………………………………. 1

Literature Review ………………………………… 2

Methods ………………………………………….. 6

Participants ……………………………………. 6

Procedure ……………………………………….. 8

Results ………………………………………….. 10

Discussion ………………………………………. 15

Appendices ………………………………………. 20

References ………………………………………. 21

APA Table of Contents Example

Here is an example of an APA-style table of contents:

I. Introduction ……………………………………………………………………. 1

II. Literature Review …………………………………………………………….. 3

A. Background………………………………………………………………… 3

B. Theoretical Framework ………………………………………………… 5

C. Empirical Studies………………………………………………………… 7

III. Methodology …………………………………………………………………. 10

A. Research Design ………………………………………………………… 10

B. Participants ……………………………………………………………….. 11

C. Materials ………………………………………………………………….. 12 ‘

D. Procedure …………………………………………………………………. 14

IV. Results …………………………………………………………………………. 16

V. Discussion ……………………………………………………………………… 19

A. Summary of Findings …………………………………………………. 19

B. Implications ………………………………………………………………. 21

C. Limitations and Future Directions ………………………………… 23

VI. Conclusion ……………………………………………………………………. 25

VII. References …………………………………………………………………… 27

VIII. Appendices ………………………………………………………………….. 31

When to use APA Table of Contents

You should use an APA TOC when:

  • You are writing a research paper or a thesis that is more than 5 pages in length.
  • Your document has multiple headings and subheadings that require organization and clarification for the reader.
  • You want to make it easy for readers to find specific sections or information within your document.
  • You want to comply with the APA style guidelines for formatting and referencing.
  • Your document contains complex information that requires a clear structure to make it more comprehensible for the reader.

Advantages of APA Table of Contents

The American Psychological Association (APA) style table of contents has several advantages, including:

  • Easy navigation: A well-organized table of contents makes it easy for readers to find the information they need quickly and easily. This is especially important in longer documents such as academic papers, theses, and dissertations.
  • Standardized formatting: The APA style table of contents follows a standardized formatting style that is familiar to many academic readers. This makes it easier for readers to understand the structure and organization of the document.
  • Consistency : By using the APA style table of contents, authors can ensure that the document is consistent and follows a clear organizational structure. This can help readers to better understand the content and stay focused on the main points.
  • Professional appearance : A well-formatted APA style table of contents can enhance the professional appearance of the document. This is particularly important in academic and research settings where a professional appearance can increase the credibility of the work.
  • Compliance with academic standards : Many academic institutions require the use of the APA style for academic papers, theses, and dissertations. By using the APA style table of contents, authors can ensure that their work complies with these academic standards.

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How to Write a Term Paper: A Complete Guide With Examples

You just got your term paper assignment and have no idea what to do or how to start? This guide will navigate you through every step of the process, from idea formation to final editing and proofreading. We will start with outlining, drafting and brainstorming, and get you through the writing part in no time. So, let’s dive into the question of how to write a term paper.

If you want to know everything you will need about term papers, this guide, written by the writers at the best essay writing service will help you along.

Table of Contents

What is a term paper.

A term paper is an academic milestone more so than anything else. As a student, you are tasked with learning and then transmitting that knowledge to others. A term paper is just that, a way to show what you have learnt, and disseminate the knowledge to others. Unlike other types of academic writing , a term paper is more detailed, requires more research, and is generally seen as the hardest piece of written work aside from a thesis.

what-is-a-term-paper

The aim of a term paper is to showcase your understanding of the subject matter and how well you handle pressure and deadlines. In this context, a term paper proves invaluable. In terms of scope, term papers may zero in on an important historical event – if you’re studying history – a scientific concept, or a contentious argument. The choice hinges on the prompt created by your academic advisor. The typical length of a term paper can stretch to five or seven pages, and is generally the prerequisite to attend end-of-semester examination. But, it is also a part of the weighted grade you’ll receive, which only adds to its importance.

For the average student, writing a term paper takes around two weeks, and is a process many do not fully understand. Term paper starts from a very basic element, a question.

Say your teacher wants you to analyze the arguments for and against US involvement in World War II. How would you start? By asking a question; something like: Why did the US enter the war? Or, why did the US waive its neutrality and entered the war.

This opens the door for you and allows you to find an article or two that then leads to the second step, and so on and so on, until you are done. The problem is many students do not know how the process works, or what skills are needed to get the job done. To write an excellent paper you need to plan carefully, adapt to new conditions, be analytical yet persuasive, and understand how referencing works. In addition, the paper has to be formatted to specifications of your chosen citation style – APA, MLA, Chicago/Turabian, Harvard, etc. This is a lot of work!

What is the Purpose of a Term Paper

At its core, a term paper serves to test your ability to understand arguments and defend them using written constructs within a pre-determined time period. Put simply, it tests your ability to navigate complex ideas when faced with a deadline – something that comes in handy in almost every job you’ll ever have later in life. If you can understand a complex event, a scientific theory, or a debatable stance, based on the directive from your academic mentor, you can manage pretty much anything that is thrown your way.

A typical term paper will be between five to seven pages, and represents the pinnacle of writing tasks in the semester. The process of term paper writing, even when the topic is prescribed, can be an arduous and time-consuming undertaking. To succeed you need meticulous planning, good composition skills, and scrupulous analysis, structure, and edit

Doing the Basics Right Saves You Time

As Seneca famously said, “Luck Is What Happens When Preparation Meets Opportunity.” In short, prepare, prepare, prepare. To create a perfect term paper you need to know, well in advance, how it will look, what will it be about, and how will it be structured. This then allows you to simply fill in the blanks as you go. But, if you start a day before submission, you’re toast – or, you can always ask for help from us J – because the result will be Red Bull frenzy induced compilation of internet’s best hits. And trust me when I say, your teacher has those stored in memory; you’re not the first student to turn a deaf ear on old Seneca….

term-paper-doing-the-basics-right

So, let’s see how to start your term paper:

  • Select your topic – If possible choose something that you’re personally interested in. When you choose early, all the good topics are still free, so keep that in mind.
  • Research your topic – Once chosen, sit at your computer and run through Google Scholar or your University Library for anything that pops up when you type in your exact topic.
  • Create an outline – When you have a basic understanding of the topic, prepare an outline. It’s always going to be fairly standard, so once you get it right, you can re-use whenever you need to in the future.
  • Thesis statement – Now starts the tricky part. Just kidding, this is still the Top Lane, we’re not even close to the Jungle. Thesis statements are always pretty similar. Jolt down your guiding question and then, based on what you’ve read, write a one sentence argument. For example, if writing about solar and wind, you might go with: Solar and wind power are the future of energy production because fossil fuels are unsustainable.
  • Topics, topic sentences, and paragraphs – Every paragraph starts with a topic sentence that describes what the paragraph is talking about. The easiest way to understand is this. If writing a paper about wind and solar, you would need at least three topic sentences – 1)Wind 2)Solar 3)Benefits of using wind and solar. Naturally, a term paper needs much more than just three, but you get the idea.
  •   Conclusion – Once you’ve written down the topic sentences and outlined the paper, note your own expectations of what you’ll find in the conclusion. This will help you understand what is happening, and when you’re actually writing the conclusion it will tell you if you were right or wrong.

Pro tip: If all of this is too much for you, there is always the possibility of asking professionals for help. Our team of term paper writers are here to help, so feel free to reach out!

Structure of a Term Paper

As you’ve probably guessed by now, every paper has to have a specific structure. In general, you can expect to have at least three parts – introduction, body, and a conclusion. However, longer papers may need several sub-sections, perhaps even an abstract or a summary, and a page dedicated to bibliography.

A typical term paper has three to five body paragraphs that form the backbone of your arguments and analytical discourse. A bibliography is always needed, even if your sources predominantly comprise course materials or excerpts from consulted textbooks. Depending on the chosen style, you will need either a Works Cited page (MLA), a Reference page (APA) or a Bibliography (Harvard, Chicago). Given its pivotal role in determining your final course grade, make sure to adhere to the highest writing and editing standards.

Term Paper Outline

  • Title page – this is where you enter your name, teacher name, school, class, and date. The formatting will depend on your chosen style
  • Introduction – Introduction sets the stage for your arguments. This is where you present statistics, define helpful terms, and finally present your thesis statement. IMPORTANT: Thesis statement is always the last sentence in the introduction.
  • Body 1: Historical setting or development
  • Body 2: Current state of knowledge about the problem
  • Body 3: Main argument and potential implications
  • Body 4: Argument for
  • Body 5: Argument against
  • Body 6: Summary
  • Conclusion : Bring all of the body arguments together and restate your thesis statement.
  • Bibliography : Provide references for all sources cited in the term paper using the style of your choice

Now let’s get to the nitty gritty of the writing process.

Topic Selection – In most cases teachers or instructors will provide students with a list of pre-approved topics to choose from. But, in some cases you will get the opportunity to choose for yourself. This is both a blessing and a curse, because it can lead you into a deep pit of despair if you are not careful.

Length – Every paper will have an assigned length. You should never go under the minimum or the maximum word/page count, as that will take points away from your final score. If the prompt asks for 10 pages, write that.

Sources – Consult your school library, Google Scholar, and any other database that has access to journals and books on your topic.

Simplify – While it is admirable to be able to write in a high-brow voice, it’s much better to use plain language as much as possible, but staying within the confines of academic jargon. No don’t’s, couldnt’s, or should’ve. If something is too complicated to explain simply, you do not understand it properly. Ask for clarification.

Do not be afraid to wander – Choosing a common topic may be a safe bet, but your teacher will grade you higher if you take a topic nobody else even though about. Brownie points are there for the taking. Just make sure you know what you’re talking about!

Don’t overextend – While the entire combined histories of all monastic orders may seem like an interesting topic (well, to us at least), it is waaaaaaay too broad to cover in 5 or 10 pages. Heck, that would probably take an entire compendium with multiple volumes. In short, don’t be a megalomaniac and choose a topic that fits in 5 pages.

How-to-Write-a-Term-Paper-The-Writing-Process

How to Write a Term Paper: The Writing Process

Before starting your write up, the teacher will expect a proposal. This is a very short summary of the topic, your thesis statement, and a few sources. The goal is to present a topic that you can defend and ask the teacher to approve it.

So how do you write a proposal? Start by writing down your thesis statement and guiding question. Then identify three to four sources and jolt down key statistics and pieces of information that are linked to your thesis statement. The goal is to show you’ve done the work. The proposal will generally have a full outline (see above) so that the teacher knows what you are planning to do. If you explain what the topic is and why it is important in writing , the teacher will accept the proposal.

Introduction, well, Introduces the Term Paper

Your essay has to start strong, which is why 99.99%  of all introductions start with a hook that captivates the audience. A hook can be anything, a statistic (like 40% of people in the US have no savings whatsoever, which means around 140 million people are completely broke – now that’s a hook, line, and sinker).

Once you know the reader is hooked, you present a brief overview of the topic you will discuss. This is where you bring statistics, data, and broader theories or concepts that may relate.

The end of the introduction is always reserved for the thesis statement, which is the last sentence of the introduction.

Try to be concise – not more than ¾ of a page (cca 200-250 words), but detailed enough so that the reader understands what the paper is about.

Writing the Body Sections

When you are certain you can understand the concepts and arguments presented in the literature, it’s time to write your body paragraphs.

The goal is to provide the reader with enough context and argumentation to prove your point. So, if you’re writing about the advantages of nuclear energy, you have to provide evidence from the literature as well as a thorough analysis of all benefits and drawbacks. The goal is to be as objective as possible, while ensuring your results are accurate.

Do not dwell on too much detail, you cannot fit all of the information in a 5 – 10 page paper. Isolate the most important pieces of evidence, maybe 3-4 and focus on those.

As a rule of thumb, you will aim for 4 – 5 body paragraphs minimum, but in most cases you will need more. The first section should be the literature review, where you analyze state-of-the-art of the topic you are writing about.

Following the literature review is your analysis, which draws from the information you’ve collected. It’s important to note, do not try and make up new stuff, or draw conclusions in this section. Simply analyze and summarize the findings in your own voice.

The last paragraph of the body section can be your own summary, where you present a different opinion. Be concise and do not go into too much detail, simply note if you think there are any discrepancies in the literature.

Remember : Always start your paragraphs with a topic sentence and try to contain the information within the paragraph to the topic.

Writing the Conclusion

Conclusion is the most important part of the term paper, even though many do not give it enough attention. This is where you put everything you’ve written together and summarize key findings.

Important : Conclusion is not the place to add new information or knowledge!

To write a good conclusion keep in mind your initial research question and thesis statement. The goal of the term paper is to answer the question and prove your thesis statement is correct. Has your paper done this? Write it down and explain why or why not your initial proposal was correct. A thesis statement can be wrong, and you must acknowledge this in your conclusion.

In the conclusion:

  • Summarize your findings
  • Discuss implications for future reseasrch

Editing and Finalization

The final word of the conclusion has been written, references added and alphabetized, the paper and the title page formatted. You are finally done. Or, maybe not! Now is the time for the final edit.

Teachers, above everything else, hate reading papers with spelling mistakes and poor grammar. To make sure your paper does not annoy the teacher (you don’t want a lower grade), make sure it is completely free of any errors.

The best way to do this is by using a machine learning tool combined with close reading on your own. The machine will weed out the glaring errors, and you will finish the job.

Read through the draft carefully. Remove any fluff or excess words that add nothing to the argument. You will likely find several sentences you will want to change. Do this now. Once done, start the second read-through.

In this read-through you will hone in on the arguments. Do they make sense? Are statistics properly cited, and do you sound coherent? If the answer is no, you will want to fix the mistakes until satisfied.

Now, finally, you are done! Congratulations. Pat yourself on the back. Oh, wait, we forgot about the abstract!

Abstract Comes First, or Last

In no uncertain terms, do not write the abstract before you’ve completed the term paper. This is always the last part of the writing process, but strangely enough the one your paper starts with. Go figure.

When you do get to this stage, use our secret formula. Well, it’s not really secret but we like to think so. The abstract needs three parts to work well, the introduction, the method/procedure, and the conclusion/findings. Depending on the topic these will vary slightly but you will always find them in an abstract.

Introduce your topic and what you plan to do in two to three sentences.

Describe what method you will use – such as literature review, an experiment, or something else. Two to three sentences.

Define the results you obtained after using the method. Two to three sentences.

Remember : The abstract should be between 120 and 200 words in length, no more is needed.

No, they are not. A research paper is an original piece of writing that comes after some type of original research has been done. Maybe you’ve found a new civilization during a dig, or a new chemical element. The research paper is meant to publicize this finding so other scientists can critique, refute, or confirm its validity. A term paper is a much simpler version that requires no original research. But, a term paper is your preparation for writing a research paper later in life.

This will depend on your teacher. In many cases, you will get a pre-defined format to follow, such as APA, MLA, or Chicago. If not, we recommend using APA or Harvard, as they are relatively simple to learn and have a ton of resources to help you along.

It is important to remember you are not writing a book, so keep the topic narrow. For example, if writing about renewable energy, choose only one type of energy or just one region. Do not try to cram everything into 5-10 pages; it won’t work.

Writing a term paper is certainly a challenge, but it is also manageable if you dedicate yourself to the process. Prepare well in advance, read a lot, and do not be afraid to ask for help if you get stuck. Your teachers are paid to help you, so email them if you get stuck. Above everything, make sure you are interested in the topic, as that will make the process so much easier.

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  • Dissertation Table of Contents in Word | Instructions & Examples

Dissertation Table of Contents in Word | Instructions & Examples

Published on 15 May 2022 by Tegan George .

The table of contents is where you list the chapters and major sections of your thesis, dissertation, or research paper, alongside their page numbers. A clear and well-formatted table of contents is essential, as it demonstrates to your reader that a quality paper will follow.

The table of contents (TOC) should be placed between the abstract and the introduction. The maximum length should be two pages. Depending on the nature of your thesis, dissertation, or paper, there are a few formatting options you can choose from.

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Table of contents

What to include in your table of contents, what not to include in your table of contents, creating a table of contents in microsoft word, table of contents examples, updating a table of contents in microsoft word, other lists in your thesis, dissertation, or research paper, frequently asked questions about the table of contents.

Depending on the length of your document, you can choose between a single-level, subdivided, or multi-level table of contents.

  • A single-level table of contents only includes ‘level 1’ headings, or chapters. This is the simplest option, but it may be too broad for a long document like a dissertation.
  • A subdivided table of contents includes chapters as well as ‘level 2’ headings, or sections. These show your reader what each chapter contains.
  • A multi-level table of contents also further divides sections into ‘level 3’ headings. This option can get messy quickly, so proceed with caution. Remember your table of contents should not be longer than 2 pages. A multi-level table is often a good choice for a shorter document like a research paper.

Examples of level 1 headings are Introduction, Literature Review, Methodology, and Bibliography. Subsections of each of these would be level 2 headings, further describing the contents of each chapter or large section. Any further subsections would be level 3.

In these introductory sections, less is often more. As you decide which sections to include, narrow it down to only the most essential.

Including appendices and tables

You should include all appendices in your table of contents. Whether or not you include tables and figures depends largely on how many there are in your document.

If there are more than three figures and tables, you might consider listing them on a separate page. Otherwise, you can include each one in the table of contents.

  • Theses and dissertations often have a separate list of figures and tables.
  • Research papers generally don’t have a separate list of figures and tables.

Prevent plagiarism, run a free check.

All level 1 and level 2 headings should be included in your table of contents, with level 3 headings used very sparingly.

The following things should never be included in a table of contents:

  • Your acknowledgements page
  • Your abstract
  • The table of contents itself

The acknowledgements and abstract always precede the table of contents, so there’s no need to include them. This goes for any sections that precede the table of contents.

To automatically insert a table of contents in Microsoft Word, be sure to first apply the correct heading styles throughout the document, as shown below.

  • Choose which headings are heading 1 and which are heading 2 (or 3!
  • For example, if all level 1 headings should be Times New Roman, 12-point font, and bold, add this formatting to the first level 1 heading.
  • Highlight the level 1 heading.
  • Right-click the style that says ‘Heading 1’.
  • Select ‘Update Heading 1 to Match Selection’.
  • Allocate the formatting for each heading throughout your document by highlighting the heading in question and clicking the style you wish to apply.

Once that’s all set, follow these steps:

  • Add a title to your table of contents. Be sure to check if your citation style or university has guidelines for this.
  • Place your cursor where you would like your table of contents to go.
  • In the ‘References’ section at the top, locate the Table of Contents group.
  • Here, you can select which levels of headings you would like to include. You can also make manual adjustments to each level by clicking the Modify button.
  • When you are ready to insert the table of contents, click ‘OK’ and it will be automatically generated, as shown below.

The key features of a table of contents are:

  • Clear headings and subheadings
  • Corresponding page numbers

Check with your educational institution to see if they have any specific formatting or design requirements.

Write yourself a reminder to update your table of contents as one of your final tasks before submitting your dissertation or paper. It’s normal for your text to shift a bit as you input your final edits, and it’s crucial that your page numbers correspond correctly.

It’s easy to update your page numbers automatically in Microsoft Word. Simply right-click the table of contents and select ‘Update Field’. You can choose either to update page numbers only or to update all information in your table of contents.

In addition to a table of contents, you might also want to include a list of figures and tables, a list of abbreviations and a glossary in your thesis or dissertation. You can use the following guides to do so:

  • List of figures and tables
  • List of abbreviations

It is less common to include these lists in a research paper.

All level 1 and 2 headings should be included in your table of contents . That means the titles of your chapters and the main sections within them.

The contents should also include all appendices and the lists of tables and figures, if applicable, as well as your reference list .

Do not include the acknowledgements or abstract   in the table of contents.

To automatically insert a table of contents in Microsoft Word, follow these steps:

  • Apply heading styles throughout the document.
  • In the references section in the ribbon, locate the Table of Contents group.
  • Click the arrow next to the Table of Contents icon and select Custom Table of Contents.
  • Select which levels of headings you would like to include in the table of contents.

Make sure to update your table of contents if you move text or change headings. To update, simply right click and select Update Field.

The table of contents in a thesis or dissertation always goes between your abstract and your introduction.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

George, T. (2022, May 15). Dissertation Table of Contents in Word | Instructions & Examples. Scribbr. Retrieved 6 May 2024, from https://www.scribbr.co.uk/thesis-dissertation/contents-page/

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How to Write a Table of Contents

Last Updated: February 16, 2024 Fact Checked

This article was co-authored by Stephanie Wong Ken, MFA . Stephanie Wong Ken is a writer based in Canada. Stephanie's writing has appeared in Joyland, Catapult, Pithead Chapel, Cosmonaut's Avenue, and other publications. She holds an MFA in Fiction and Creative Writing from Portland State University. This article has been fact-checked, ensuring the accuracy of any cited facts and confirming the authority of its sources. This article has been viewed 1,048,260 times.

The Table of Contents in a document acts as a map for the reader, making it easier for them to find information in the document based on title and page number. A good Table of Contents should be organized, easy to read and simple to use. You can write a Table of Contents manually on your computer or have a word processing tool create it for you. Make sure the Table of Contents is formatted properly in your final document so it is as accurate and accessible as possible.

Sample Tables of Contents

example of table of contents in term paper

Creating the Table of Contents on a Word Processor

Step 1 Start a new page after the title page.

  • The Table of Contents should be on its own page. Do not include the introduction or a dedication on the same page as the Table of Contents.

Step 2 List the headings of the document in order.

  • For example, you may write down main headings like, “Introduction,” “Case Study 1,” or “Conclusion.”

Step 3 Add subheadings if applicable.

  • For example, under the main heading “Introduction” you may write the subheading, “Themes and Concepts.” Or under the main heading “Conclusion” you may write, “Final Analysis.”
  • You can also include sub-subheadings underneath the subheadings, if applicable. For example, under the subheading “Themes and Concepts” you may have the sub-subheading, “Identity.”
  • Some papers do not have subheadings at all, only main headings. If this is the case, skip this step.

Step 4 Write page numbers for each heading.

  • For example, if the “Introduction” section begins on page 1, you will attach “page 1” to the Introduction heading. If the “Conclusion” section begins on page 45, attach “page 45” to the Conclusion heading.

Step 5 Put the content in a table.

  • Check that the subheadings are located underneath the correct headings, indented to the right.
  • Make sure there are page numbers for the subheadings listed as well.
  • You can center the content in the table using the table options if you want the content to appear a few spaces away from the lines of the table. You can also leave the content indented to the left if you'd prefer.

Step 6 Title the Table of Contents.

  • You can put the title above the table or in a separate row on the top of the rest of the content.

Using a Word Processing Tool

Step 1 Confirm the headings and page numbers are correct in the document.

  • You should also confirm the page numbers are correct in the document. Each page should be numbered in order. Having the correct page numbers will ensure the Table of Contents is created correctly when you use the word processing tool.

Step 2 Open the Styles tab.

  • If there are subheadings in your document, label them “Heading 2.” Highlight each subheading and click on “Heading 2” in the Styles tab.
  • If there are sub-subheadings in your document, label them “Heading 3.” Highlight each subheading and click on “Heading 3” in the Styles tab.
  • The text and font for each main heading may change based on the settings for “Heading 1,” “Heading 2,” and “Heading 3.” You can choose your preferred text and font for each main heading so they appear as you like in the Table of Contents.

Step 4 Start a new page after the title page.

  • You can choose the built-in Table of Content options, where the tool will automatically choose a font size and style for you.
  • You can also go for from a list of custom Table of Contents, where you choose the font color and size based on your preferences.

Polishing the Table of Contents

Step 1 Make sure the headings are formatted correctly.

  • You should also check the subheadings or sub-subheadings in the Table of Contents, if applicable, to ensure they match those in the document.

Step 2 Confirm the page numbers match the document.

  • If you created the Table of Contents manually, do this by going in and adjusting the headings and/or the page numbers when they change.
  • If you created the Table of Contents with a word processing tool, update it by clicking the Update option by the Table of Contents option on the Reference tab. You can side clicking on the Table of Contents and choosing “update” that way.

Community Q&A

Community Answer

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Write a Manual

  • ↑ https://edu.gcfglobal.org/en/word-tips/how-to-create-a-table-of-contents-in-word/1/#
  • ↑ https://examples.yourdictionary.com/reference/examples/table-of-content-examples.html
  • ↑ http://bitesizebio.com/21549/using-word-to-write-your-thesis-making-a-table-of-contents-inserting-captions-and-cross-referencing/
  • ↑ https://guides.lib.umich.edu/c.php?g=283073&p=1886010
  • ↑ https://nsufl.libguides.com/c.php?g=413851&p=2820026

About This Article

Stephanie Wong Ken, MFA

To write a table of contents, open a new document and list the major headings, titles, or chapters of the project in chronological order. Next, insert subheadings or subtopics if your project has those. Fill in the page number where each heading starts, then format the content in a table with 2 columns. Place the headings and subheadings in order in the first column, then put the page numbers in the second column. Don't forget to add a "Table of Contents" title at the top of the document! To learn more about polishing your Table of Contents, read on! Did this summary help you? Yes No

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Thesis / dissertation formatting manual (2024).

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  • Preliminary Pages Overview
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  • Dedication Page

Table of Contents

  • List of Figures (etc.)
  • Acknowledgements
  • Text and References Overview
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The Table of Contents should follow these guidelines:

  • ​All sections of the manuscript are listed in the Table of Contents except the Title Page, the Copyright Page, the Dedication Page, and the Table of Contents.
  • You may list subsections within chapters
  • Creative works are not exempt from the requirement to include a Table of Contents

Table of Contents Example

Here is an example of a Table of Contents page from the Template. Please note that your table of contents may be longer than one page.

Screenshot of Table of Contents page from Dissertation template

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How to Write a Table of Contents for Different Formats With Examples

  • 11 December 2023

Rules that guide academic writing are specific to each paper format. However, some rules apply to all styles – APA, MLA, Chicago/Turabian, and Harvard. Basically, one of these rules is the inclusion of a Table of Contents (TOC) in an academic text, particularly long ones, like theses, dissertations, and research papers. When writing a TOC, students or researchers should observe some practices regardless of paper formats. Also, it includes writing the TOC on a new page after the title page, numbering the first-level and corresponding second-level headings, and indicating the page number of each entry. Hence, scholars need to learn how to write a table of contents in APA, MLA, Chicago/Turabian, and Harvard styles.

General Guidelines

When writing academic texts, such as theses, dissertations, and other research papers, students observe academic writing rules as applicable. Generally, the different paper formats – APA, MLA, Chicago/Turabian, and Harvard – have specific standards that students must follow in their writing. In this case, one of the rules is the inclusion of a Table of Contents (TOC) in the document. By definition, a TOC is a roadmap that scholars provide in their writing, outlining each portion of a paper. In other words, a TOC enables readers to locate specific information in documents or revisit favorite parts within written texts. Moreover, this part of academic papers provides readers with a preview of the paper’s contents.

How to write a table of contents

For writing your paper, these links will be helpful:

  • Buy Research Paper
  • How to Write a Research Paper
  • How to Write a Research Proposal
  • How to Write a Term Paper
  • How to Write a Case Study

Difference Between a Table of Contents and an Outline

In essence, a TOC is a description of first-level headings (topics) and second-level headings (subtopics) within the paper’s body. For a longer document, writers may also include third-level titles to make the text palatable to read. Ideally, the length of papers determines the depth that authors go into detailing their writing in TOCs. Basically, this feature means that shorter texts may not require third-level headings. In contrast, an essay outline is a summary of the paper’s main ideas with a hierarchical or logical structuring of the content. Unlike a TOC that only lists headings and subheadings, outlines capture these headings and then describe the content briefly under each one. As such, an outline provides a more in-depth summary of essay papers compared to a TOC.

How to Write a Table of Contents in APA

When writing a TOC in the APA format , writers should capture all the headings in the paper – first-level, second-level, and even third-level. Besides this information, they should also include an abstract, references, and appendices. Notably, while a TOC in the APA style has an abstract, this section is not necessary for the other formats, like MLA, Chicago/Turabian, and Harvard. Hence, an example of a Table of Contents written in the APA format is indicated below:

Example of a table of contents in APA

How to Write a Table of Contents in MLA

Unlike papers written in the APA style, MLA papers do not require a Table of Contents unless they are long enough. In this case, documents, like theses, dissertations, and books written in the MLA format should have a TOC. Even where a TOC is necessary, there is no specific method that a writer should use when writing it. In turn, the structure of the TOC is left to the writer’s discretion. However, when students have to include a TOC in their papers, the information they capture should be much more than what would appear in the APA paper . Hence, an example of writing a Table of Contents in MLA format is:

Example of a table of contents in MLA

In the case of writing a research paper, an example of a Table of Contents should be:

Example of a table of contents for a research paper in MLA

How to Write a Table of Contents in Chicago/Turabian

Like the MLA style, a Chicago/Turabian paper does not require writing a Table of Contents unless it is long enough. When a TOC is necessary, writers should capitalize on major headings. Additionally, authors do not need to add a row of periods (. . . . . . . .) between the heading entry and the page number. Moreover, the arrangement of the content should start with the first-level heading, then the second-level heading, and, finally, the third-level title, just like in the APA paper. In turn, all the information that precedes the introduction part should have lowercase Roman numerals. Also, the row of periods is only used for major headings. Hence, an example of writing a Table of Contents in a Chicago/Turabian paper is:

Example of a table of contents in Chicago/Turabian

How to Write a Table of Contents in Harvard

Like in the other formats, writing a Table of Contents in the Harvard style is captured by having the title “Table of Contents” at the center of the page, in the first line. Basically, it comes after the title page and captures all the sections and subsections of Harvard papers. In other words, writers must indicate first-level headings in a numbered list. Also, scholars should align titles to the left side and capitalize them. In turn, if there is a need to show second-level headings, authors should list them under corresponding first-level headings by using bullet points. However, it is essential for students not to disrupt the numbering of first-level headings. Moreover, writers should align second-level headings to the left side and indent them by half an inch and capitalize on this content. Hence, an example of writing a Table of Contents in a Harvard paper should appear as below:

Example of a table of contents in Harvard

A Table of Content (TOC) is an essential component of an academic paper , particularly for long documents, like theses, dissertations, and research papers. When students are writing a TOC, they should be careful to follow the applicable format’s rules and standards. Regardless of the format, writers should master the following tips when writing a TOC:

  • Write the TOC on a new page after the title page.
  • Indicate first-level headings of the document in a numbered list.
  • Indicate second-level headings under the corresponding first-level heading.
  • If applicable, indicate third-level headings under the corresponding second-level heading.
  • Write the page number for each heading.
  • Put the content in a two-column table.
  • Title the page with “Table of Contents.”

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How to Write a Term Paper From Start to Finish

example of table of contents in term paper

The term paper, often regarded as the culmination of a semester's hard work, is a rite of passage for students in pursuit of higher education. Here's an interesting fact to kick things off: Did you know that the term paper's origins can be traced back to ancient Greece, where scholars like Plato and Aristotle utilized written works to explore and document their philosophical musings? Just as these great minds once wrote their thoughts on parchment, you, too, can embark on this intellectual voyage with confidence and skill.

How to Write a Term Paper: Short Description

In this article, we'll delve into the core purpose of this kind of assignment – to showcase your understanding of a subject, your research abilities, and your capacity to communicate complex ideas effectively. But it doesn't stop there. We'll also guide you in the art of creating a well-structured term paper format, a roadmap that will not only keep you on track but also ensure your ideas flow seamlessly and logically. Packed with valuable tips on writing, organization, and time management, this resource promises to equip you with the tools needed to excel in your academic writing.

Understanding What Is a Term Paper

A term paper, a crucial component of your college education, is often assigned towards the conclusion of a semester. It's a vehicle through which educators gauge your comprehension of the course content. Imagine it as a bridge between what you've learned in class and your ability to apply that knowledge to real-world topics.

For instance, in a history course, you might be asked to delve into the causes and consequences of a significant historical event, such as World War II. In a psychology class, your term paper might explore the effects of stress on mental health, or in an environmental science course, you could analyze the impact of climate change on a specific region.

Writing a term paper isn't just about summarizing facts. It requires a blend of organization, deep research, and the art of presenting your findings in a way that's both clear and analytical. This means structuring your arguments logically, citing relevant sources, and critically evaluating the information you've gathered.

For further guidance, we've prepared an insightful guide for you authored by our expert essay writer . It's brimming with practical tips and valuable insights to help you stand out in this academic endeavor and earn the recognition you deserve.

How to Start a Term Paper

Before you start, keep the guidelines for the term paper format firmly in mind. If you have any doubts, don't hesitate to reach out to your instructor for clarification before you begin your research and writing process. And remember, procrastination is your worst enemy in this endeavor. If you're aiming to produce an exceptional piece and secure a top grade, it's essential to plan ahead and allocate dedicated time each day to work on it. Now, let our term paper writing services provide you with some valuable tips to help you on your journey:

start a term paper

  • Hone Your Topic : Start by cultivating a learning mindset that empowers you to effectively organize your thoughts. Discover how to research a topic in the section below.
  • Hook Your Readers: Initiate a brainstorming session and unleash a barrage of creative ideas to captivate your audience right from the outset. Pose intriguing questions, share compelling anecdotes, offer persuasive statistics, and more.
  • Craft a Concise Thesis Statement Example : If you find yourself struggling to encapsulate the main idea of your paper in just a sentence or two, it's time to revisit your initial topic and consider narrowing it down.
  • Understand Style Requirements: Your work must adhere to specific formatting guidelines. Delve into details about the APA format and other pertinent regulations in the section provided.
  • Delve Deeper with Research : Equipped with a clearer understanding of your objectives, dive into your subject matter with a discerning eye. Ensure that you draw from reputable and reliable sources.
  • Begin Writing: Don't obsess over perfection from the get-go. Just start writing, and don't worry about initial imperfections. You can always revise or remove those early sentences later. The key is to initiate the term papers as soon as you've amassed sufficient information.

Ace your term paper with EssayPro 's expert help. Our academic professionals are here to guide you through every step, ensuring your term paper is well-researched, structured, and written to the highest standards.

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Term Paper Topics

Selecting the right topic for your term paper is a critical step, one that can significantly impact your overall experience and the quality of your work. While instructors sometimes provide specific topics, there are instances when you have the freedom to choose your own. To guide you on how to write a term paper, consider the following factors when deciding on your dissertation topics :

choose a term paper topic

  • Relevance to Assignment Length: Begin by considering the required length of your paper. Whether it's a substantial 10-page paper or a more concise 5-page one, understanding the word count will help you determine the appropriate scope for your subject. This will inform whether your topic should be broad or more narrowly focused.
  • Availability of Resources : Investigate the resources at your disposal. Check your school or community library for books and materials that can support your research. Additionally, explore online sources to ensure you have access to a variety of reference materials.
  • Complexity and Clarity : Ensure you can effectively explain your chosen topic, regardless of how complex it may seem. If you encounter areas that are challenging to grasp fully, don't hesitate to seek guidance from experts or your professor. Clarity and understanding are key to producing a well-structured term paper.
  • Avoiding Overused Concepts : Refrain from choosing overly trendy or overused topics. Mainstream subjects often fail to captivate the interest of your readers or instructors, as they can lead to repetitive content. Instead, opt for a unique angle or approach that adds depth to your paper.
  • Manageability and Passion : While passion can drive your choice of topic, it's important to ensure that it is manageable within the given time frame and with the available resources. If necessary, consider scaling down a topic that remains intriguing and motivating to you, ensuring it aligns with your course objectives and personal interests.

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Term Paper Outline

Before embarking on the journey of writing a term paper, it's crucial to establish a well-structured outline. Be mindful of any specific formatting requirements your teacher may have in mind, as these will guide your outline's structure. Here's a basic format to help you get started:

  • Cover Page: Begin with a cover page featuring your name, course number, teacher's name, and the deadline date, centered at the top.
  • Abstract: Craft a concise summary of your work that informs readers about your paper's topic, its significance, and the key points you'll explore.
  • Introduction: Commence your term paper introduction with a clear and compelling statement of your chosen topic. Explain why it's relevant and outline your approach to addressing it.
  • Body: This section serves as the meat of academic papers, where you present the primary findings from your research. Provide detailed information about the topic to enhance the reader's understanding. Ensure you incorporate various viewpoints on the issue and conduct a thorough analysis of your research.
  • Results: Share the insights and conclusions that your research has led you to. Discuss any shifts in your perspective or understanding that have occurred during the course of your project.
  • Discussion: Conclude your term paper with a comprehensive summary of the topic and your findings. You can wrap up with a thought-provoking question or encourage readers to explore the subject further through their own research.

How to Write a Term Paper with 5 Steps

Before you begin your term paper, it's crucial to understand what a term paper proposal entails. This proposal serves as your way to introduce and justify your chosen topic to your instructor, and it must gain approval before you start writing the actual paper.

In your proposal, include recent studies or research related to your topic, along with proper references. Clearly explain the topic's relevance to your course, outline your objectives, and organize your ideas effectively. This helps your instructor grasp your term paper's direction. If needed, you can also seek assistance from our expert writers and buy term paper .

how to write a term paper

Draft the Abstract

The abstract is a critical element while writing a term paper, and it plays a crucial role in piquing the reader's interest. To create a captivating abstract, consider these key points from our dissertation writing service :

  • Conciseness: Keep it short and to the point, around 150-250 words. No need for lengthy explanations.
  • Highlight Key Elements: Summarize the problem you're addressing, your research methods, and primary findings or conclusions. For instance, if your paper discusses the impact of social media on mental health, mention your research methods and significant findings.
  • Engagement: Make your abstract engaging. Use language that draws readers in. For example, if your paper explores the effects of artificial intelligence on the job market, you might begin with a question like, 'Is AI revolutionizing our work landscape, or should we prepare for the robots to take over?'
  • Clarity: Avoid excessive jargon or technical terms to ensure accessibility to a wider audience.

Craft the Introduction

The introduction sets the stage for your entire term paper and should engage readers from the outset. To craft an intriguing introduction, consider these tips:

  • Hook Your Audience: Start with a captivating hook, such as a thought-provoking question or a compelling statistic. For example, if your paper explores the impact of smartphone addiction, you could begin with, 'Can you remember the last time you went a whole day without checking your phone?'
  • State Your Purpose: Clearly state the purpose of your paper and its relevance. If your term paper is about renewable energy's role in combating climate change, explain why this topic is essential in today's world.
  • Provide a Roadmap: Briefly outline how your paper is structured. For instance, if your paper discusses the benefits of mindfulness meditation, mention that you will explore its effects on stress reduction, emotional well-being, and cognitive performance.
  • Thesis Statement: Conclude your introduction with a concise thesis statement that encapsulates the central argument or message of your paper. In the case of a term paper on the impact of online education, your thesis might be: 'Online education is revolutionizing learning by providing accessibility, flexibility, and innovative teaching methods.'

Develop the Body Sections: Brainstorming Concepts and Content

Generate ideas and compose text: body sections.

The body of your term paper is where you present your research, arguments, and analysis. To generate ideas and write engaging text in the body sections, consider these strategies from our research paper writer :

  • Structure Your Ideas: Organize your paper into sections or paragraphs, each addressing a specific aspect of your topic. For example, if your term paper explores the impact of social media on interpersonal relationships, you might have sections on communication patterns, privacy concerns, and emotional well-being.
  • Support with Evidence: Back up your arguments with credible evidence, such as data, research findings, or expert opinions. For instance, when discussing the effects of social media on mental health, you can include statistics on social media usage and its correlation with anxiety or depression.
  • Offer Diverse Perspectives: Acknowledge and explore various viewpoints on the topic. When writing about the pros and cons of genetic engineering, present both the potential benefits, like disease prevention, and the ethical concerns associated with altering human genetics.
  • Use Engaging Examples: Incorporate real-life examples to illustrate your points. If your paper discusses the consequences of climate change, share specific instances of extreme weather events or environmental degradation to make the topic relatable.
  • Ask Thought-Provoking Questions: Integrate questions throughout your text to engage readers and stimulate critical thinking. In a term paper on the future of artificial intelligence, you might ask, 'How will AI impact job markets and the concept of work in the coming years?'

Formulate the Conclusion

The conclusion section should provide a satisfying wrap-up of your arguments and insights. To craft a compelling term paper example conclusion, follow these steps:

  • Revisit Your Thesis: Begin by restating your thesis statement. This reinforces the central message of your paper. For example, if your thesis is about the importance of biodiversity conservation, reiterate that biodiversity is crucial for ecological balance and human well-being.
  • Summarize Key Points: Briefly recap the main points you've discussed in the body of your paper. For instance, if you've been exploring the impact of globalization on local economies, summarize the effects on industries, job markets, and cultural diversity.
  • Emphasize Your Main Argument: Reaffirm the significance of your thesis and the overall message of your paper. Discuss why your findings are important or relevant in a broader context. If your term paper discusses the advantages of renewable energy, underscore its potential to combat climate change and reduce our reliance on fossil fuels.
  • Offer a Thoughtful Reflection: Share your own reflections or insights about the topic. How has your understanding evolved during your research? Have you uncovered any unexpected findings or implications? If your paper discusses the future of space exploration, consider what it means for humanity's quest to explore the cosmos.
  • End with Impact: Conclude your term paper with a powerful closing statement. You can leave the reader with a thought-provoking question, a call to action, or a reflection on the broader implications of your topic. For instance, if your paper is about the ethics of artificial intelligence, you could finish by asking, 'As AI continues to advance, what ethical considerations will guide our choices and decisions?'

Edit and Enhance the Initial Draft

After completing your initial draft, the revision and polishing phase is essential for improving your paper. Here's how to refine your work efficiently:

  • Take a Break: Step back and return to your paper with a fresh perspective.
  • Structure Check: Ensure your paper flows logically and transitions smoothly from the introduction to the conclusion.
  • Clarity and Conciseness: Trim excess words for clarity and precision.
  • Grammar and Style: Proofread for errors and ensure consistent style.
  • Citations and References: Double-check your citations and reference list.
  • Peer Review: Seek feedback from peers or professors for valuable insights.
  • Enhance Intro and Conclusion: Make your introduction and conclusion engaging and impactful.
  • Coherence Check: Ensure your arguments support your thesis consistently.
  • Read Aloud: Reading your paper aloud helps identify issues.
  • Final Proofread: Perform a thorough proofread to catch any remaining errors.

Term Paper Format

When formatting your term paper, consider its length and the required citation style, which depends on your research topic. Proper referencing is crucial to avoid plagiarism in academic writing. Common citation styles include APA and MLA.

If unsure how to cite term paper for social sciences, use the APA format, including the author's name, book title, publication year, publisher, and location when citing a book.

For liberal arts and humanities, MLA is common, requiring the publication name, date, and location for referencing.

Adhering to the appropriate term paper format and citation style ensures an organized and academically sound paper. Follow your instructor's guidelines for a polished and successful paper.

Term Paper Example

To access our term paper example, simply click the button below.

The timeline of events from 1776 to 1861, that, in the end, prompted the American Civil War, describes and relates to a number of subjects modern historians acknowledge as the origins and causes of the Civil War. In fact, pre-Civil War events had both long-term and short-term influences on the War—such as the election of Abraham Lincoln as the American president in 1860 that led to the Fall of Fort Sumter in April of the same year. In that period, contentions that surrounded states’ rights progressively exploded in Congress—since they were the initial events that formed after independence. Congress focused on resolving significant issues that affected the states, which led to further issues. In that order, the US’s history from 1776 to 1861 provides a rich history, as politicians brought forth dissimilarities, dissections, and tensions between the Southern US & the people of slave states, and the Northern states that were loyal to the Union. The events that unfolded from the period of 1776 to 1861 involved a series of issues because they promoted the great sectional crisis that led to political divisions and the build-up to the Civil War that made the North and the South seem like distinctive and timeless regions that predated the crisis itself.

Final Thoughts

In closing, approach the task of writing term papers with determination and a positive outlook. Begin well in advance, maintain organization, and have faith in your capabilities. Don't hesitate to seek assistance if required, and express your individual perspective with confidence. You're more than capable of succeeding in this endeavor!

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How do I format a table of contents in MLA style?

Note: This post relates to content in the eighth edition of the MLA Handbook . For up-to-date guidance, see the ninth edition of the MLA Handbook .

Tables of contents may be formatted in a number of ways. In our publications, we sometimes list chapter numbers before chapter titles and sometimes list the chapter titles alone. We also sometimes list section heads beneath the chapter titles. After each chapter or heading title, the page number on which the chapter or section begins is provided. The following show examples from three of the MLA’s books.

From Elizabeth Brookbank and H. Faye Christenberry’s  MLA Guide to Undergraduate Research in Literature  (Modern Language Association of America, 2019):

From  Approaches to Teaching Bechdel’s  Fun Home, edited by Judith Kegan Gardiner (Modern Language Association of America, 2018):

From the  MLA Handbook , 8th ed. (Modern Language Association of America, 2016):

Need more information? Read about where to place a table of contents in your paper .

example of table of contents in term paper

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Example for Table of Contents

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Inhaltsverzeichnis

  • 1  Definition
  • 3 Examples for Your Thesis
  • 4 Master’s Thesis Examples
  • 5  Microsoft Word Tutorial
  • 6 In a Nutshell

 Definition

A table of contents example will help structure a long academic manuscript and a table of contents page is necessary for academic submission. The table of contents contains an organised listing of your manuscript’s chapters and sections with clearly marked (and accurate) page numbers. The aim of the table of contents is to allow the reader to flip easily to the section they require and to get a feel of your argument’s structure.

What comes first, table of contents or abstract?

If you are writing an academic paper, you have to take the order of your paper into account. Usually, the first sections of your thesis are the title page, cover page, acknowledgements and the abstract . After these pages, you place the table of contents. Be sure to check that all of the page numbers in your table of contents are correct.

What variations of table of content examples exist?

The table of contents can be displayed in the following formats:

  • Single level table of contents
  • Subdivided table of contents
  • Multi-level table of contents
  • Academic table of contents

You will find further details about what needs to be included inside of the table of contents on our blog.

Are references included in table of contents?

Yes. The references are included in the table of contents. You add them in as you would any other section of your thesis. Simply write the section in the table of contents with the corresponding page number. However, the acknowledgement for thesis   and the abstract are usually not included in the table of contents. However, check with your institution as this could be dependent upon the formatting that you’re required to follow.

How can I make a table of contents in Microsoft Word?

On Microsoft Word, you will find the function to create a table of contents under the ‘references’ tab. Click on the tab and select ‘table of contents’. You can use one that has been designed by Microsoft Word, or you can create a custom one by yourself. Scroll down for a full tutorial on Microsoft Word and creating a table of contents.

Examples for Your Thesis

Below, you will find different examples for table of contents, including a

  • Single level table of contents example
  • Subdivided table of contents example
  • Multi-level table of contents example

We will also show you with an example how the table of contents for a bachelor’s thesis could look like, as well as for a master’s thesis.

Advice for creating a good table of contents: A good table of contents must be easy to read and formatted accurately, containing quick reference pages for all figures and illustrations. A table of contents example will help you structure your own thesis, but remember to make it relevant to your discipline. Table of contents example structures can be created for different disciplines, such as social sciences, humanities and engineering.

The type and length of a table of contents example will depend on the manuscript. Some thesis’ are short, containing just several chapters, whilst others (like a PhD thesis) are as lengthy as a book. This length will dictate the amount of detail that goes into forming a table of contents example page and the amount of “levels” (or subdivisions) in each chapter.

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Single Level Table of Contents Example

For shorter documents, a single level table of contents example can be used. This is a short and succinct table of contents example which utilises only single-level entries on sections or chapters. Remember, you’ll need to include properly formatted dots to lead the reader’s eye to the page number on the far right. The following table of contents example explores this basic structure:

Table-of-Contents-Example-Single-level-1

Subdivided Table of Contents E xample

A subdivided table of contents example is required for more lengthy papers, offering a subdivision of chapters and sections within chapters. These are more detailed and are recommended for higher-level dissertations like masters or PhD thesis’ (as well as some more detailed bachelor’s dissertations).

When formating subdivided table of contents example, ensure that chapters are listed in bold font and that subsections are not. It’s common (though not necessary) to denote each subsection by a number (1.1, etc.). You’ll also want to indent the subsections so that they can be read easily. The following table of contents example explores this structure:

Table-of-Contents-Example-Subdivided-table

Multi-level Table of Contents E xample

Adding additional levels to your table of contents is known as a multi-level table of contents example. These would be numbered onwards at 1.1.1, etc. Be aware that although you want to guide your reader through your manuscript, you should only highlight important areas of your manuscript, like sections and sub-sections, rather than random areas or thoughts in your manuscript. Creating too many levels will make your table of contents unnecessarily busy and too complex.

Table-of-Contents-Example-multi-level

Academic Table of Contents

All of the above can be used as an academic table of contents example. Often, each separate heading in an academic work needs to be both numbered and labelled in accordance with your preferred reference style (consult your department). The following table of contents example sections will illustrate a table of contents example for a bachelor thesis and a table of contents example for a master thesis.

Table of Contents Example: Bachelor’s Thesis

A bachelor’s degree thesis has no set word or page limit nationwide and will depend entirely on your university or department’s guidelines. However, you can expect a thesis under 60 pages of length at between 10,000 – 15,000 words. As such, you won’t be expected to produce a long and detailed table of contents example with multiple levels and subsections. This is because your main body is more limited in terms of word count. At most, you may find yourself using a subdivided table of contents similar to the table of contents example above.

A bachelor’s thesis table of contents example may be structured like so:

Table-of-Contents-Example-Bachelor-Thesis-1

This table of contents example may change depending on your discipline and thesis structure, but note that a single-level structure will often suffice. Subdivided structures like the table of contents example listed earlier will only be necessary when writing several chapters, like in a Master’s thesis.

Master’s Thesis Examples

A master’s table of contents example is more complex than a bachelor’s thesis. This is because they average at about 80 pages with up to 40,000 words. Because this work is produced at a higher academic level, it normally includes a subdivision of chapters and subheadings, with a separate introduction and conclusion, as well as an abstract.

A table of contents example for a master’s thesis may then look something like this:

Table-of-Contents-Example-Master-Thesis

 Microsoft Word Tutorial

Creating a table of contents page with Microsoft Word is simple.

In a Nutshell

  • All theses are different. Various departments and disciplines follow different structures and rules. The table of contents example pages here will help you in general to format your document, but remember to consult your university guidelines
  • Consistency and accuracy are the most important things to remember. You need the correct page number and the same layout for each chapter. It’s no good combining single-level table of contents with a multi-level table of contents
  • Simply put, bachelor’s thesis’ generally follow a single-level table of contents example unless otherwise specified
  • Postgraduate thesis’ like master and PhD-level work generally require a more detailed subdivision table of contents example. This is because they deal with both more complex arguments and more words
  • Remember to include all aspects of your thesis within the table of contents. Pre-thesis material needs to be listed in Roman numerals and you need to include all back-matter as well, such as References and Bibliography

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How to Create a Table of Contents in Word for Your Paper? [For Students]

Working on a paper or thesis is mentally exhausting on its own, but having to format everything according to MLA, APA, or Chicago style can be a real headache, especially when creating a table of contents. Manually updating it every time you make changes is tedious and error-prone. What you really need is a way to generate and update the table of contents automatically, allowing you to concentrate on the content without worrying about the structure.

This makes the entire process smoother and less stressful, letting you focus on your research without the constant formatting frustration. In this article, we will explore the essentials of creating a functional and clear table of contents Word for students, covering what it is, why it's important, and how to prepare one that effectively outlines your paper's structure.

Table of Contents in APA, MLA and Chicago Style

In academic writing, particularly for longer pieces such as thesis, dissertations, and research papers, having a clear organization is highly beneficial. A crucial aspect that helps readers navigate your work is a Table of Contents (TOC). Despite the variations in specific style guides like APA, MLA, or Chicago, incorporating a TOC provides numerous advantages. Besides these benefits, TOCs in these three academic formats adhere to generally similar guidelines, although there are some differences that must be acknowledged and addressed.

1. A Table of Contents in APA

The American Psychological Association (APA) style is commonly used in the social sciences. While APA style does not always require a table of contents, it is often recommended for lengthy papers or theses. Here's how to structure a table of contents in APA style:

Placement : The TOC goes between the abstract and introduction on a separate page.

Formatting : Use the same font and size as your main text (typically 12 pt Times New Roman).

Title : Center and bold the word "Contents" at the top of the page.

Heading Levels : Include all level 1 (main sections) and level 2 (subheadings) headings in the TOC.

Alignment : Left-align all entries in the TOC.

Indentation : Level 2 headings are indented for clarity.

Lower Levels (Optional) : Including level 3 headings or lower is optional and requires additional indentation for each level.

Length : Keep the TOC concise; ideally, it shouldn't exceed two pages.

2. A Table of Contents in MLA

The Modern Language Association (MLA) style is typically used in the humanities. While MLA does not always require a table of contents for shorter papers, longer academic works may benefit from having one. Here are some tips for creating a table of contents in MLA style:

Font and Size : Stick to Times New Roman, 12 point size, for consistency with the rest of your document.

Margins : Use standard 1-inch margins on all sides.

Spacing : Double line spacing is the norm for MLA formatting.

Indentations : Create a clear distinction between paragraphs with a ½-inch indent for the first line.

Headings : Use title case capitalization (capitalize the first word of each main word) for your headings in the TOC.

3. A Table of Contents in Chicago Style

The Chicago Manual of Style (CMS) is widely used in historical and other academic research. Chicago style often requires a detailed table of contents for dissertations and other extensive works. Here's how to create a table of contents in Chicago style:

Starting Fresh : Begin your TOC on a separate page following the title page.

Clear Labeling : Center the title "Contents" at the top of the page.

Spacing for Readability : Leave a double space between "Contents" and the first entry in your TOC.

Mirroring Your Paper : List chapter titles, headings, and subheadings in the exact order they appear in your paper.

Matching Matters : Ensure capitalization and the hierarchy of titles/headings in the TOC match your paper's formatting.

Pinpointing Locations :  Place page numbers flush right, using leader dots (a series of periods) to connect them to the corresponding entry.

How to Create a Table of Contents Easily in Word for Your Paper

Before inserting a table of contents in Word , we first need to format the headings of our research paper or thesis according to an academic style.

Let's take a look at it through an example for better understanding. We need to write a research paper on Environment Safety, so before getting started with the writing part, let’s create an outline for it. This means we will need to lay out the headings in order. We have a main heading called Heading 1, and then we have subheadings called Heading 2. In some instances, we have Heading 3 or Heading 4 as well, so let's take a look at the breakdown of these headings beforehand.

H1 : The main heading of your document, typically used once for the overall title.

H2 : Subheadings that break down your H1 topic into major sections.

H3 : Subheadings that further divide your H2 sections into more specific points.

If you understand this, then formatting will be a breeze for you. So let's jump right into it:

Step 1 : We now have our outline laid out in our document on Microsoft Word.

Step 2 : Even though I went through and formatted my headings and subheadings by increasing the font size of the main headings and making them bold, this is completely wrong.

Step 3 : In Word, we need to do proper formatting. To do this, click on your main heading of the essay and head over to the Home tab.

Step 4 : Now, in the "Styles" section, you will see various styles. From this, click on "Heading 1", and you will notice a change in your headings formatting.

Step 5 : To change the formatting to fit your academic style, right-click on the "Heading 1" button in the Styles section to open the context menu, and then click on "Modify".

Step 6 : In the Modify Style dialog, users can change the font, font size, and other changes to format their heading.

Step 7 : Similarly, click on Heading 2 in your document, then in the Styles section, select Heading 2, and so on.

Step 8 : Once all the headings have been formatted, now we can proceed to inserting a table of contents into our document.

Step 9 : To insert the table of contents, visit the Reference tab and then click on the "Table of Contents" option in the ribbon menu.

Step 10 : Microsoft Word gives its users the option to insert a pre-formatted table of contents, but if you wish to insert a custom-made table of contents, that's also possible.

Step 11 : Once you have selected your desired table of contents, it will be added, and you can now complete your work with ease.

How to Update the Table of Contents in Word for Your Paper

The outline was ready, or at least that's what we thought, but now we added a few new headings, but they won't show up in the table of contents. Now, to address this, we need to Update our Table of Contents:

Step 1 : Let's open Microsoft Word again. As we can see, there's nothing changed in the table of contents even though we've correctly styled the headings in our essay.

Step 2 : To update the table of contents, right-click anywhere on the table of contents to open the context menu.

Step 3 : In the context menu, we need to click on "Update Field" or simply press the shortcut key "F9".

Step 4 : Now, we see the Update Table of Contents dialog. Click on "Update entire table" and then click "OK".

Step 5 : The table of contents will now be completely updated with the new headings that you've inserted.

Bonus Tip: Converting Your Paper to PDF Without Losing Format

Once you're done with your paper and a well-organized table of contents, the next step is often converting it to a PDF. This is crucial because PDFs preserve formatting, ensuring that your hard work doesn't get scrambled when shared or printed. However, conversion can be tricky, especially with Microsoft Word 365. When converting a document to PDF in Word 365, you might encounter issues like misaligned text, broken page breaks, or distorted table of contents formatting.

WPS Office is an excellent alternative to Microsoft Word 365 for PDF conversions. It offers robust PDF features that can convert your paper without losing formatting. Here's why WPS Office might be a better choice:

Direct PDF Conversion : WPS Office has a built-in PDF converter that maintains the layout and structure of your document, reducing the risk of misalignment.

Enhanced PDF Features : WPS Office allows you to merge, split, or compress PDFs , which can be useful if you need to adjust your document after conversion.

Easy Table of Contents Management : WPS Office handles tables of contents well, ensuring links and formatting remain intact.

WPS Office: Use Word, Excel, and PPT for FREE, No Ads.

Now, to convert your Word document with the table of contents into a PDF document without losing any formatting in the process, WPS Office provides a very easy and effective solution:

Step 1 : Let's open the Word document in WPS Office and then head over to the Menu on the top left of the page.

Step 2 : In the menu, click on "Save as" and select "Other formats" from the flyout menu.

Step 3 : Simply in the Save as options, change the file type to "PDF" in the "File Type" field and then hit "Save" to save your document as a PDF.

FAQs about Table of Contents in Word

1. how do i link headings to table of contents in word.

If you've inserted a manual table, here's how to link headings to a table of contents in Microsoft Word:

Step 1 : Go to your table of contents.

Step 2 : Select the heading in the table of contents you want to link to your document heading.

Step 3 : Right-click and choose "Link" from the context menu.

Step 4 : In the Insert Link dialog, select the "Place in This Document" tab and choose the heading you want to link to. Click OK to finish.

Step 5 : The linked heading will appear blue and underlined in your table of contents.

2. How do you update a Table of Contents in Word and keep formatting?

To adjust your current table of contents:

Step 1 : Go to the References tab.

Step 2 : Click on Table of Contents.

Step 3 : Choose Custom table of contents.

Step 4 : Use the options to change what appears in the table, how page numbers are displayed, adjust formatting, and decide how many heading levels to include.

3. How do I link a table of contents to a page in word?

Users can easily link the table of contents to pages in Word by applying heading styles to document sections and then clicking on the Update tab in the Reference tab.a

Perfect Your Paper: Mastering Table of Contents with WPS Office

Your thesis or report isn't complete without a table of contents, especially if it's a requirement. Forgetting this crucial section could lead to a lower grade, which might have been avoided by simply adding a well-structured table of contents. To ensure your report meets the necessary academic standards, not only should you include a  table of contents Word for students, but you should also make sure it's correctly formatted according to the guidelines.

WPS Office is the ideal tool for writing your paper, thanks to its robust formatting capabilities. It's particularly useful when you need to share your document or convert it to PDF, as WPS Office maintains your formatting without glitches. So, if you haven't tried WPS Office yet, consider downloading it now to streamline your writing process and keep your formatting consistent.

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Original research article, older adults' experiences of wellbeing during the covid-19 pandemic: a comparative qualitative study in italy and switzerland.

example of table of contents in term paper

  • 1 Faculty of Social Sciences, University of Geneva, Geneva, Switzerland
  • 2 Swiss Center of Expertise in Life Course Research (LIVES), Geneva, Switzerland
  • 3 Faculty of Social Work, University of Applied Sciences and Arts Western Switzerland (HETSL/HES-SO), Lausanne, Switzerland

Background: Particularly at the beginning of the pandemic, adults aged 65 and older were portrayed as a homogeneously vulnerable population due to the elevated health risks associated with contracting the COVID-19 disease. This portrayal, combined with travel restrictions, closures of economic sectors, country-wide lockdowns, and suggestions by governmental authorities to limit social contact, had important implications for the wellbeing of older individuals. However, older adults are a heterogeneous population who relies on different resources to cope with stressful periods, like the COVID-19 pandemic. Simultaneously, countries also employed different measures to contain the virus. Research thus far has focused on the short-term consequences of the pandemic, but studies have yet to address its long-term consequences.

Objectives: We explore older adults' lived experiences nearly 2 years after the pandemic onset. Moreover, we focus on the bordering countries of Switzerland and Italy, who employed contrasting containment measures. This paper analyzes (1) How the COVID-19 pandemic impacted the experiences of wellbeing of older adults in these regions and (2) How older adults coped with the stressors brought about by the pandemic, in particular social distancing.

Methods: The paper draws on 31 semi-structured interviews with 11 Swiss natives residing in Switzerland, 10 Italian migrants residing in Switzerland, and 10 Italian natives residing in Italy. Interviews were conducted from December 2021 to March 2022.

Results: Coping mechanisms of the three groups related to acceptance, hobbies, cognitive reframing, telephone use, vaccine use and social distancing. However, results show heterogeneous experiences of wellbeing, with Swiss natives sharing more positive narratives than the other two groups. Moreover, Italian migrants and Italian natives expressed the long-term negative consequences of the pandemic on their experienced wellbeing.

1 Introduction

In March of 2020, the WHO declared COVID-19 a pandemic, making it an international public health problem ( WHO, 2020 ). Beyond physical illness, the pandemic disrupted millions of lives around the globe through closures of schools, shops, and borders; it separated individuals from friends and family, and it caused job losses and financial strain ( Hiscott et al., 2020 ). However, in the public discourse it was especially older adults who were portrayed as a homogeneously vulnerable and frail group ( Jordan et al., 2020 ; Ayalon et al., 2021 ; Maggiori et al., 2022 ). Indeed, older people had higher mortality rates than younger ones ( Dadras et al., 2022 ). They also suffered from decreased physical activity due to social distancing measures, impacting their physical health ( Oliveira et al., 2022 ). Moreover, in comparison to pre-pandemic levels, older adults reported higher rates of anxiety and depression ( Webb and Chen, 2022 ; Segerstrom et al., 2023 ) and lower subjective wellbeing ( Maggiori et al., 2022 ).

However, compared to their younger counterparts, older adults also reported less pandemic-related stress, less social isolation, less life changes ( Birditt et al., 2021 ), and lower rates of anxiety and depression ( Webb and Chen, 2022 ). Furthermore, older adults' resilience was shown through their ability to develop coping strategies to maintain a certain level of subjective and psychological wellbeing ( Finlay et al., 2021 ; Fuller and Huseth-Zosel, 2021 ; Bustamante et al., 2022 ; Facal et al., 2022 ; Mau et al., 2022 ).

Nonetheless, the ability to cope with the stressors brought about by the pandemic was influenced by factors on the micro-, meso-, and macro- levels. On the micro-level, studies have revealed that characteristics like being in good health, previous experiences of adversity, stable financial status, and social networks positively affected individuals' ability to cope with the pandemic ( Guzman et al., 2023 ), while having a migration background was associated with increased pandemic-related worry ( Ludwig-Dehm et al., 2023 ) and loneliness ( Pan et al., 2021 ). At the meso-level, neighborhood parks and nature were positively related to mental and physical health ( Bustamante et al., 2022 ; Guzman et al., 2023 ). At the macro-level, stricter physical distancing measures mandated by governments were associated with worse mental health ( Mendez-Lopez et al., 2022 ). The heterogeneity of older adults' characteristics, resources, and lived experiences, as well as the differences in countries' containment measures thus call for research further exploring how older adults coped with the pandemic in different contexts.

Most studies to date focus on older individuals' wellbeing during the first lockdown in the spring of 2020 ( Seifert and Hassler, 2020 ; Cipolletta and Gris, 2021 ; Falvo et al., 2021 ; Finlay et al., 2021 ; Fuller and Huseth-Zosel, 2021 ; McKinlay et al., 2021 ; Whitehead and Torossian, 2021 ; Bustamante et al., 2022 ; Facal et al., 2022 ; Gonçalves et al., 2022 ; Kremers et al., 2022 ) or during the first year following the pandemic onset ( Fiocco et al., 2021 ; Atzendorf and Gruber, 2022 ; Brooks et al., 2022 ; Cohn-Schwartz et al., 2022 ; Derrer-Merk et al., 2022a ; Garner et al., 2022 ; Maggiori et al., 2022 ; Mau et al., 2022 ; Donizzetti and Capone, 2023 ). However, few studies have been published thus far addressing the second year of the pandemic and its long-term impact on older adults' wellbeing ( Gallè et al., 2021 ; König and Isengard, 2023 ). Moreover, studies have analyzed the pandemic's impact on the physical health of migrants of all ages in comparison to native-born populations in Western Europe ( Canevelli et al., 2020 ; Aldea, 2022 ; Khlat et al., 2022 ), but to the best of our knowledge, none have addressed the differences in the lived experiences of wellbeing among older migrant and native populations with a focus on coping strategies. Furthermore, there is a paucity of literature comparing the experiences of wellbeing and coping strategies between countries that implemented contrasting COVID-19 containment measures.

We aim to bridge this gap by comparing the experiences of older adults in Italy and Switzerland – countries that implemented different COVID-19 containment measures – nearly 2 years after the pandemic onset. Specifically, we study older Swiss natives residing in Switzerland, older Italian natives residing in Italy, and older Italian migrants residing in Switzerland. This allows us to explore the experiences of wellbeing of older adults who lived under strict restriction measures, namely Italian residents, to those of adults who lived under more relaxed measures, namely Swiss natives and Italian migrants living in Switzerland. Furthermore, comparing Swiss natives and Italian migrants allows us to analyze the experiences of two groups who lived the pandemic in the same context, yet who have had different life courses. More particularly, because older Italian migrants in Switzerland often have attachments to Italy and take part in transnational practices ( Ludwig-Dehm et al., 2023 ), their inclusion in the study allows us to explore how the situation in their country of origin impacted their COVID-19 experiences from abroad.

This paper aims to analyze (1) How the COVID-19 pandemic impacted the experiences of wellbeing of older adults in Switzerland and Italy and (2) How older adults coped with the stressors brought about by the pandemic, in particular social distancing.

2 Contextual background: the Swiss and Italian contexts

Despite the geographical proximity between Switzerland and Italy, the two countries implemented quite different containment measures as a response to the virus.

Compared to other European countries, on average Switzerland implemented less stringent containment measures throughout the pandemic, despite being just as impacted ( Pleninger et al., 2022 ). The first phase of the pandemic, classified by the Federal Council as an “extraordinary situation,” lasted from March 16 to June 19, 2020 ( Sager and Mavrot, 2020 ; Maggiori et al., 2022 ; Pleninger et al., 2022 ). From March 16 until April 26, the Swiss government gradually imposed measures closing borders, canceling cultural and sports events, banning all public and private manifestations, closing schools, restaurants, bars, as well as shops and services deemed to be unessential, and banning gatherings of more than five people. Older adults in particular were advised to stay at home and to avoid in-person social interactions with members outside their household. From April 26, 2020 containment measures were slowly eased, and on June 19, 2020, the classification of the pandemic changed from “extraordinary” to “special” ( Sager and Mavrot, 2020 ; Pleninger et al., 2022 ).

During the next 2 years, Switzerland saw a series of tightening and easing of containment measures, which included regulations on mandatory vaccines or COVID-19 tests to access bars and restaurants, and mandatory masks to be worn in shops and public transport. All restrictions were then lifted on April 1, 2022 ( FOPH, 2022 ).

Throughout the pandemic up until the data collection for this article – between December 2021 and March 2022 – the Swiss government largely relied on cooperation from the public. Although in certain periods shops, restaurants, and schools were closed, Swiss residents still enjoyed a certain amount of freedom to move and have social gatherings, albeit limited. Overall, it was left up to the individuals to regulate their behaviors within certain limits.

The Italian government, on the other hand, imposed more stringent measures throughout the pandemic. Late January 2020, the government declared a national emergency, and in February 2020, Italy was the epicenter of the health crisis in Europe ( Ferrante, 2022 ). The Italian government quickly established lockdown “red” zones in certain areas of Northern Italy, which led to the closure of schools and restrictions of movement: residents could leave their areas of residence only for necessities like work, health reasons or family emergencies, or grocery shopping. These restrictions were applied in waves to the entire country, and on March 11 the government imposed a national lockdown, also named the “stay at home” decree ( Bull, 2021 ). This entailed closure of borders, schools, restaurants and bars, and all nonessential shops and services. Travel between regions was prohibited and residents' movement was only allowed for essential reasons. The first Italian lockdown ended on May 3, 2020, after which most shops, restaurants, bars, and services gradually reopened while maintaining COVID-19 safety protocols ( Bosa et al., 2021 ).

During the next 2 years, Italy also experienced a series of loosening and tightening of restrictions, but these were often more stringent than the ones imposed in Switzerland. For instance, during the second wave of the pandemic, which took place in autumn of 2020 and winter of 2021, curfews from 11 pm to 5 am were mandated and restaurants and bars had to close at 6 pm. During this time, Italian residents were strongly recommended to leave their homes only for work or health reasons, and these restrictions were gradually eased by mid-2021 ( SkyTG24, 2020 ; Bosa et al., 2021 ). In April 2022, Italy declared an end to the state of emergency, and thereafter lifted all restrictions ( Amanto, 2022 ).

Both Italy and Switzerland were successful in containing the spread of the virus ( Ferrante, 2022 ; Pleninger et al., 2022 ), but at what cost to people's wellbeing?

3 A theoretical framework to understand wellbeing and coping strategies among older adults

3.1 wellbeing.

Research on wellbeing largely encompasses two forms: objective wellbeing and subjective wellbeing. The first refers to objective indicators like income, health, and living conditions. The second refers to individuals' experiences of wellbeing and to their evaluations of their lives. It is often measured with indicators like positive and negative affect, happiness, life satisfaction, and satisfaction with various life domains like social relationships, financial situation, and neighborhood conditions ( Bartram, 2012 ; Diener, 2012 ; Veenhoven, 2012 , 2017 ). In this paper, we use the term wellbeing to refer to the latter concept – to individuals' subjective experiences of wellbeing.

Some objective indicators are indeed correlated to subjective indicators – being in good health, for instance is positively associated with life satisfaction ( Helliwell, 2003 ; Deaton, 2008 ; Clark et al., 2018 ) and, to a certain extent, so is income ( Clark et al., 2008 ; Clark, 2011 ; De Jong, 2015 ). Studies have also debated to what extent wellbeing is dependent on genes and individual personality traits ( Bartels, 2015 ; Røysamb et al., 2018 ), and to what extent it is dependent on external factors like social contexts and life events ( Helliwell and Putnam, 2004 ). But overall, the consensus is that wellbeing is influenced by both genetic and environmental characteristics ( Røysamb et al., 2014 ; Luhmann et al., 2021 ).

Most studies employ a quantitative approach and explore a wide array of determinants of wellbeing, ranging from age, to health, to income and education, to relationships and divorce, to social norms and institutions, and so on ( Clark et al., 2018 ). Qualitative studies on wellbeing are less common ( Bartram, 2012 ), but they valuably provide information on participants' perceptions, views and beliefs that are unaffected by researchers' pre-determined ideologies ( Delle Fave et al., 2011 ). Especially in a context like that of the COVID-19 pandemic – a disruptive process that homogeneously categorized an entire group as vulnerable and forced individuals world-wide to reorganize their lives – a qualitative approach allows for nuanced, in-depth analyses of people's experiences of wellbeing (and vulnerability).

3.2 Older adults' vulnerability

Independently of the pandemic context, older adults are often characterized as particularly frail and vulnerable ( Fried et al., 2001 ; Clegg et al., 2013 ). This is often due the age-related decline in physiological and psychological systems, which renders this population vulnerable to falls, hospitalization, or sudden health changes triggered by minor events, and makes them more reliant on others for care ( Fried et al., 2001 ; Clegg et al., 2013 ). But vulnerability in old age is not a dichotomous state of vulnerable vs. not vulnerable, as was suggested in the public discourse during the COVID-19 pandemic. According to the life-course approach employed by Spini et al. (2017) , vulnerability is defined as:

“a weakening process and a lack of resources in one or more life domains that, in specific contexts, exposes individuals or groups to (1) negative consequences related to sources of stress, (2) an inability to cope effectively with stressors, and (3) an inability to recover from stressors or to take advantage of opportunities by a given deadline.” ( Spini et al., 2017 , p. 8)

It is a dynamic process between stress and resources that occurs at the intersection of different areas of life (like health, work, family, etc.), and on several levels (macro-, meso-, or micro-levels) throughout the life course ( Spini et al., 2017 ). When faced with a stressful situation like the COVID-19 pandemic, individuals must rely on the resources they accumulated throughout the life course – referred to as reserves ( Cullati et al., 2018 ) – in order to cope with life adversities. These reserves include, but are not limited to, physical and mental health, economic savings, cultural capital resulting from education, social networks, and emotional and cognitive reserves ( Cullati et al., 2018 ). It is in times of shocks that these reserves become the most important and mediate the impact of stressors on individuals' wellbeing; it is also during these adverse periods that inequalities between individuals' reserves become the most apparent ( Widmer, 2022 ), leading to situations of vulnerability.

In old age, physical reserves diminish, and older adults' ability to fight infectious diseases decreases, putting them in a vulnerable situation ( Bajaj et al., 2021 ). However, physical reserves are related to events and conditions throughout the lifespan. For example, the combination of disadvantageous childhood socioeconomic conditions, coupled with adverse adult socioeconomic conditions, increase the probability of chronic health diseases ( Galobardes et al., 2007 ). Aging adults are thus not all equally vulnerable to the risks associated with COVID-19; their vulnerability is associated to a wide variety of life-course experiences and factors, only some of which directly related to age ( Oris et al., 2020 ; Sneed and Krendl, 2022 ).

3.3 Pandemic impact on older adults' wellbeing

In the context of the COVID-19 pandemic, researchers have studied different measures related to wellbeing, like loneliness, social isolation, worry, anxiety, and others. This section draws on the literature focusing on various experiences of wellbeing during the pandemic among older adults.

Following the implementation of virus containment and social distancing measures, many countries reported an increase in loneliness among older adults in comparison to pre-pandemic levels ( Luchetti et al., 2020 ; Seifert and Hassler, 2020 ; Holaday et al., 2021 ; Macdonald and Hülür, 2021 ; Rodney et al., 2021 ; Van Tilburg et al., 2021 ; Zaninotto et al., 2022 ; see also literature review by Su et al., 2023 ). Feelings of loneliness were particularly prevalent among older adults with no children, lower-income individuals, those living alone, and those reporting depressive symptoms ( Seifert and Hassler, 2020 ; O'Shea et al., 2021 ), which highlights the role of resources and reserves in mediating the pandemic's impact on wellbeing.

Furthermore, older adults in countries all around the world experienced higher levels of stress, worry, anxiety, and depression in comparison to pre-pandemic levels. These negative mental health outcomes were more common among older single adults, among older adults of lower socioeconomic groups ( Kola et al., 2021 ; Webb and Chen, 2022 ; Wettstein et al., 2022a ; Zaninotto et al., 2022 ), among those with poor self-rated health ( Wettstein et al., 2022a ), and among those who were already socially isolated prior to the pandemic ( Macleod et al., 2021 ). Social isolation is correlated to declining physical and mental health, increased mortality, and lower quality of life, and the social distancing measures introduced by the pandemic exacerbated these risks ( Macleod et al., 2021 ).

Most studies published to date, in May 2023, concentrate on the initial weeks of the pandemic and largely focus on singular countries. Atzendorf and Gruber (2022) 's research, however, focused on the weeks following the first wave, between June and August 2020 and used SHARE data to analyze the medium-term consequences of the first pandemic wave across 25 European countries and Israel. They found that older adults in countries with high death rates and stringent measures were at increased risk of feeling depressed or lonely. Similarly, Mendez-Lopez et al. (2022) used the same data and revealed that countries' greater stringency in physical distancing measures was associated with worse mental health. This is particularly pertinent for this paper, as both Italy and Switzerland were badly hit by the pandemic ( Ferrante, 2022 ; Pleninger et al., 2022 ), but they differed in containment strategies: while Italian residents were severely limited in their mobility, Swiss residents benefitted from a certain amount of freedom. Atzendorf and Gruber (2022) revealed that Italian older adults reported increased feelings of loneliness and depression after the pandemic onset to a greater extent than Swiss older adults.

The only study to date analyzing older adults' wellbeing during the two years following the pandemic onset showed that most older Europeans did not feel lonely before or during the pandemic. However, for some, feelings of loneliness increased, particularly among the less educated, those living alone, and those isolated at home ( König and Isengard, 2023 ).

Moreover, the characterization of older adults as a homogeneous, exceptionally vulnerable population ( Petretto and Pili, 2020 ; Seifert, 2021 ) engendered negative self-perceptions of aging ( Losada-Baltar et al., 2021 ; Seifert, 2021 ), which have been associated with loneliness and psychological distress among older adults ( Losada-Baltar et al., 2021 ). Their homogenous representation and the resulting ageist narrative also led to feelings of anger, increased anxiety, and perceptions of loss of autonomy and individualism by this older population ( Derrer-Merk et al., 2022a , b ).

Although research has documented the negative impact of the pandemic on older adults, studies have also suggested that in some ways, older adults did not suffer as much as their younger counterparts, as documented in the literature review by Seckman (2023) . Older adults in the United States reported less pandemic-related stress, less social isolation ( Birditt et al., 2021 ), and greater emotional wellbeing ( Carstensen et al., 2020 ) than younger adults. The same result was found among Chinese adults ( Jiang, 2020 ). Similarly, in Italy older adults reported less loneliness compared to younger age groups ( Luchetti et al., 2020 ).

Independently of the pandemic context, older migrants are more vulnerable to loneliness and social isolation due to language and cultural barriers, low social capital, and dependence on children for support ( Neville et al., 2018 ; Sidani et al., 2022 ). Moreover, older migrants often occupy disadvantaged socioeconomic positions and are in worse health than natives in the host country ( Bolzman and Vagni, 2018 ; WHO, 2018 ). The pandemic and the related reduced social contacts may have thus rendered older migrants particularly vulnerable to social isolation, loneliness and negative mental health outcomes ( Pan et al., 2021 ; Sidani et al., 2022 ). In fact, a study on older Chinese migrants in Belgium and the Netherlands revealed that reduced social participation and financial insecurity increased migrants' loneliness levels ( Pan et al., 2021 ).

Furthermore, migrants often engage in transnational practices, linking them in various ways to their country of origin ( Ciobanu and Ludwig-Dehm, 2020 ). The pandemic restrictions changed some of these transnational practices through travel bans and border closures ( Nehring and Hu, 2022 ), which may influence older migrants' wellbeing. A survey conducted within the same research project as this paper, found that Italian migrants in Switzerland reported higher levels of worry about the COVID-19 pandemic than Swiss natives, and this difference is largely explained by engagement in transnational practices ( Ludwig-Dehm et al., 2023 ).

Despite the increasing proportion of older migrants in Europe ( UNDESA, 2020 ), research on the impact of the pandemic on older migrants' wellbeing is scarce.

3.4 Coping strategies of older adults

Research has shown that aging adults are capable of adapting and coping to various events and circumstances ( Klausen, 2020 ; Settersten et al., 2020 ). Coping refers to the cognitive and behavioral efforts one carries out to prevent, tolerate, or diminish certain situations ( Lazarus and Folkman, 1984 ; Carver, 2013 ; Biggs et al., 2017 ), and studies have found that older adults are particularly able to engage in such behaviors to diminish stressors ( Yancura and Aldwin, 2008 ; Carstensen et al., 2020 ). Coping strategies are often grouped into emotion-focused and problem-focused strategies ( Lazarus and Folkman, 1984 ; Aldwin and Revenson, 1987 ; Biggs et al., 2017 ). The first refers to strategies intended to regulate one's emotional reactions to the problem, while the latter refers to behaviors and cognitions aimed at directly managing or solving a problem ( Yancura and Aldwin, 2008 ; Biggs et al., 2017 ). This includes strategies aimed at avoiding thinking about the problem – like keeping oneself busy – as well as strategies aimed at finding the positive aspects of a stressful situation ( Aldwin and Yancura, 2004 ).

Older adults' ability to engage in these strategies can be partly explained by Carstensen's (2021) Socioemotional Selectivity Theory, which posits that social and emotional goals change depending on the perception of how much time one has left to live. As one grows older or approaches the end of their life due to illnesses or frailty, goals shift and people tend to value smaller and more meaningful social networks, they tend to spend more time with close partners, and they use cognitive resources to process more positive information ( Carstensen, 2021 ).

Another aspect related to older adults' coping abilities concerns the aforementioned reserves accumulated throughout the life-course. Accumulation of social resources, cultural and economic capital, health reserves, and the acquisition of coping skills allow older adults to endure stressful situations or, on the contrary, the lack of such reserves can penalize them ( Grundy, 2006 ; Cullati et al., 2018 ; Settersten et al., 2020 ).

In addition to the wellbeing consequences for older adults, studies have addressed the coping mechanisms developed by this population throughout the first wave of the pandemic. In a qualitative study, Gonçalves et al. (2022) interviewed older adults in Brazil, the United States, Italy, and Portugal, and revealed that social isolation engendered feelings of restriction in terms of interaction with friends and family and ability to participate in leisure activities. At the same time, older adults were also able to cope with the situation by dedicating their time to hobbies, using technological resources to stay close to friends and family, or involving themselves in religious and spiritual activities. Despite the different cultures and contexts of this study's participants, researchers found homogeneity in their coping mechanisms. Several studies confirmed these findings with different samples of older U.S. American adults ( Finlay et al., 2021 ; Fuller and Huseth-Zosel, 2021 ; Whitehead and Torossian, 2021 ), and Bustamante et al. (2022) revealed that time spent in parks and outdoor spaces boosted physical, mental, and social wellbeing.

Similarly, Mau et al. (2022) found that for older Danish adults, adapting to the situation by reframing their mindset, finding ways to maintain social contacts and a sense of community, and staying active were important coping behaviors that helped them maintain a good level of wellbeing. In Italy, older adults experienced the first pandemic wave in heterogeneous ways: those who felt alone pre-pandemic expressed that isolation had a negative impact on their wellbeing. Others were able to cope with the situation by exploring hobbies and maintaining contacts with friends and family through telephone use ( Cipolletta and Gris, 2021 ).

However, the only study on older migrants' wellbeing and coping strategies by Pan et al. (2021) found that neither problem-focused coping strategies, nor emotion-focused coping protected against increased loneliness during the pandemic.

These studies reveal that, at least for the first half of 2020, older adults employed coping mechanisms to endure the pandemic, but we still know little of their experiences after the first COVID-19 wave. A longitudinal qualitative study on Canadian older persons explored their experiences over a 10-month period from May 2020 to February 2021 ( Brooks et al., 2022 ). It found that the longevity of pandemic restrictions was partially responsible for older adults' declines in wellbeing. Simultaneously, participants used similar coping mechanism employed during the first pandemic wave to maintain their wellbeing: they stayed active, found ways to stay in contact with friends and family, and adopted positive mindsets.

Nonetheless, cross-country research on the experiences of wellbeing among older adults, and more particularly in the years following the pandemic onset, is still scarce. We therefore aim to bridge this gap by exploring the lived experiences and coping mechanisms of older individuals in two countries that had contrasting COVID-19 containment measures like Italy and Switzerland. Furthermore, we analyze how having connections to both countries, as is the case of Italian migrants in Switzerland, influences the lived experiences of these individuals.

4 Data and methods

Our study focuses on three groups of older adults (65+): (1) Swiss natives, defined as individuals who were born in Switzerland and whose parents were also born in Switzerland, (2) Italian international migrants from the south of Italy, defined as individuals who were born in southern Italy, whose parents were also born in Italy, and who migrated to Switzerland, and (3) Italian natives, defined as those who were born in the south of Italy, resided in the south of Italy at the time of the research, and whose parents were also born in Italy. There are several reasons for the inclusion of these specific groups in our study. First, Italians constitute one of the largest cohorts of foreign nationals aged 65 and above residing in Switzerland ( FSO, 2020 ). Second, a significant part of older Italians migrated to Switzerland between the 1950s and 1970s, with the majority originating from economically disadvantaged regions of Southern Italy ( Wessendorf, 2007 ). They primarily migrated for financial reasons or to reunite with family who had relocated as labor migrants ( Bolzman et al., 2004 ; Riaño and Wastl-Walter, 2006 ), and we therefore analyze older adults with a very specific migration background. Third, by comparing migrants from Southern Italy to natives from the same regions, we can explore the lived experiences of individuals who were raised in similar social contexts.

The sample for this paper is derived from an original quantitative survey conducted between June and November 2020 in the project TransAge: “Transnational aging among older migrants and natives: A strategy to overcome vulnerability.” Respondents to the qualitative interviews had already participated to the TransAge survey and had agreed to be further contacted for a follow-up interview. In total, 31 individuals participated to the study, of which 11 were Swiss natives, 10 were Italian migrants residing in Switzerland, and 10 were Italian natives residing in Italy.

To ensure diversity of wellbeing experiences among each of the three groups, we attempted to recruit individuals with low and high levels of life satisfaction. To do so, we based ourselves on Diener's Satisfaction with Life Scale ( Diener et al., 1985 ), included in the TransAge questionnaire. More specifically, we focused on the scale item “I am satisfied with my life.” In the survey, participants were asked to indicate the strength of their agreement with this statement on a scale ranging from 1 (strongly agree) to 7 (strongly disagree). We thus contacted a roughly equal number of participants who stated being satisfied with their lives (scores 6 or 7) and participants who were less satisfied (scores 5 or less). Simultaneously, we checked the general life satisfaction scores drawing on the 5-item scale to assure coherence between the single-item and the total score ( Diener et al., 1985 ).

The first author conducted semi-structured one-to-one interviews with the 31 community-dwelling older adults between December 2021 and March 2022, during the fifth wave of COVID-19, when social distancing was still strongly advised. Consequently, all interviews were done by telephone, 1 except for one participant who preferred to meet in person. Participation in the study was voluntary, and all participants gave oral consent to be interviewed and recorded. Interviews lasted an average of 45 min, and they were conducted in French or Italian. They were audio-recorded and subsequently transcribed verbatim and anonymized. Participant quotes in this paper were translated into English by the first author, and every participant was given a pseudonym.

Participants were asked open-ended questions that prompted them to reflect on their experiences throughout the pandemic. First, they were asked to describe their feelings at the beginning of the pandemic, any impact that the confinement period had on their wellbeing, on their social habits, oron their daily lives. They were also encouraged to share how they coped with this period. They were then asked to reflect on the years after the onset of the sanitary crisis and describe any difficulties they faced and any strategies used to surmount these difficulties. Participants were also invited to share what their daily and social lives looked like at the time of interview, and how they felt about any long-lasting changes they may have experienced.

Interviews were analyzed using an inductive thematic analysis using qualitative coding software NVivo. The study was approved by the Ethics Committee of the Faculty of Social Sciences of the University of Geneva.

5.1 Sample description

The 11 Swiss natives and 10 Italian migrants resided in the Swiss cantons of Geneva, Vaud, or Ticino, while the 10 Italian natives resided in the Italian regions of Sicily, Apulia, Sardinia, Abruzzo, Basilicata, or Campania. Participant characteristics by group are shown in Table 1 . In comparison to the larger TransAge quantitative study, there is an over-representation of participants with medium and higher level of education among Italian migrants and natives, which will be taken into consideration in the discussion of the results.

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Table 1 . Sample charactertistics.

5.2 Comparative accounts of wellbeing in times of pandemic

When recounting their experiences throughout the first 2 years of the pandemic in Switzerland and Italy, participants across the three groups coupled their narratives, whether positive or negative, with coping strategies they employed to manage the impact of the pandemic on their wellbeing. The themes that we identified correspond to emotion-focused coping and problem-focused coping strategies documented in the coping literature ( Lazarus and Folkman, 1984 ; Aldwin and Revenson, 1987 ; Biggs et al., 2017 ). Emotion-focused coping refers to strategies aimed at regulating the emotions that arise because of a stressful situation, which also includes engagement in activities as a way to distract oneself. Problem-focused coping, on the other hand, refers to behaviors and cognitions targeted toward solving or managing a problem ( Yancura and Aldwin, 2008 ). Strategies like social contact through telephone use involves elements of both emotion-focused and problem-focused coping. It refers to emotional support received by friends and family, it can entail concrete help in understanding how to confront an adverse situation, and it is a strategy directed at compensating for decreased in-person contact ( Aldwin and Yancura, 2004 ).

Table 2 shows the behaviors adopted by participants that correspond to these two overarching coping mechanisms. We found that certain strategies adopted during the first lockdown were no longer used at the time of interview. Thus, in Table 2 , we list the themes found in the data by pandemic period.

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Table 2 . Coping strategies used at pandemic onset and at time of interview.

During the first months of the pandemic, the primary emotion-focused strategies adopted by older adults in our sample related to acceptance of the health crisis, keeping busy through hobbies and exercise, appreciation of the natural environment, and attitudes aimed at “finding the silver lining,” which involves strategies aimed at trying to find the positive aspects of the problem at hand, and which the literature often refers to as cognitive reframing ( Aldwin and Yancura, 2004 ; Robson and Troutman-Jordan, 2014 ). In terms of problem-focused coping, participants evoked the importance of social distancing measures both during the initial lockdown and at the time of interview, and many later relied on vaccines as a mean to decrease the probability of severe illness.

The subsequent sections are organized as follows: First, we detail, by group, participants' experiences of wellbeing during the first lockdown and the coping strategies they adopted to face this period. Then, we analyze how social distancing measures and decreased social contacts impacted participants in each of the three groups, and we outline participants' social habits and coping strategies at the time of interview.

5.2.1 Wellbeing during the first lockdown

Although participants in all three groups used similar coping strategies throughout the pandemic, their narratives of wellbeing differed.

5.2.1.1 Experiences of Swiss natives

All Swiss native older adults, except for one, described the first confinement period in positive terms and expressed not having been particularly bothered by it. They often associated their wellbeing to being able to keep busy through various hobbies and interests, and by enjoying the natural landscapes around them, as indicated in the following excerpts:

“I think I was very relaxed…I have so many books at home...I have the watercolors, I have so many things to do here, creatively, with my hands or with my head, it doesn't bother me, so...the confinement didn't bother me at all.” (Irène, 77, F, Swiss native)     “So, at home, my wife plays the piano. She has a gentleman who comes to the house. Oh yeah, she hasn't had a lesson in a year at home, but she took lessons with Zoom. You know how it is. So, she has a lot of work, piano homework. I did a little bit of crafting. I did a little bit of Spanish with French-Spanish classes.” (Nicolas, 71, M, Swiss native)     “We remained a little locked up. But we had…it was a beautiful weather. There was the spring and everything, everything was beautiful. We enjoyed our patio. We got back to reading. We did a lot of stuff like that.” (Lydia, 79, F, Swiss native)

Some Swiss participants mentioned increased telephone use to share moments with friends and family. Others described their wellbeing by comparing themselves to others, thus engaging in cognitive strategies to frame their attitude and outlook on the situation. François, for instance, often spends part of the year in Barcelona, and when talking about his wellbeing, he compares the Swiss restrictions to those of Barcelona. He elaborates:

“We were very lucky because we weren't confined like…in Barcelona. In Switzerland, that wasn't the case. Of course, there were things we couldn't do any more, but there was still a lot for us to do. We could take the car, we could go for a walk. Well, the borders were closed. Well, we didn't suffer, my wife and I…our sons either.” (François, 81, M, Swiss native)

When reflecting on the virus-containment measures, others simply stated that they just had to accept the situation and adapt their behaviors accordingly. Pierre, for example, states:

“You have to adapt. We adapt by respecting the rules, not like people who cheat [by not following the rules]. We respect the rules, but we adapt.” (Pierre, 71, M, Swiss native)

Overall, the first months of the pandemic were described in positive terms by most of Swiss older adults. Most of them portrayed themselves as being in good health and they did not evoke fears related to the virus. However, one Swiss participant expressed the negative impact of this period on his wellbeing. He recounts:

“[We lived this period] quite badly because we were old, very old. The Ticino police chief was more or less telling everybody to put us in the freezer. I mean, not quite like that…he made a statement that caused quite a stir…[The situation] was not very conducive to being cheerful, let's say.” (Gianni, 88, M, Swiss Native)

For Gianni, the government lockdown meant being “stuck at home,” as he says, and relying on institutional support. His quote shows the way he experienced the confinement measures and the public discourse as an older-old person.

5.2.1.2 Experiences of Italian migrants in Switzerland

Similarly to Swiss natives, Italian migrants residing in Switzerland used cognitive strategies to frame the lockdown's impact on their wellbeing. They, too, evoked Switzerland's lenient containment measures as an important aspect that helped them surmount this period, particularly in terms of the freedom it gave them to spend time in nature. Giulia, for example, explains:

“Here in Switzerland, here in Geneva, I didn't feel this need for freedom like in other countries. For me, we were free here. I live near a park, I could take my walk every day. I have a small but very nice little apartment that has visibility on both sides, left and right, so I didn't feel like I was in prison.” (Giulia, 70, F, Italian migrant)

Italian migrants also turned to activities like reading, taking walks, and exercising to keep themselves busy during this period. However, although they lived the pandemic in the same context as the Swiss natives, there was more heterogeneity in Italian migrants' narratives of this containment period. While most stated that they simply accepted the situation and the lockdown did not negatively impact their wellbeing, some expressed feelings of loneliness and isolation. Gabriele (69, M), for example, says he felt isolated from the outside world at the beginning of the pandemic, he described his life during this period as monotonous. However, he kept himself busy by going on walks and exercising.

Others tried to overcome their feelings of loneliness by staying in communication with family, but it was not always helpful. When asked about any difficulties he faced during the lockdown, Alberto explains:

“A little bit of loneliness and missing family, that's it. It weighed on me a little bit. We used to phone my children, but no luck. My children also suffered; my youngest daughter suffered a lot and now we slowly recover.” (Alberto, 77, M, Italian migrant)

Italian migrants in Switzerland still hold transnational ties to their country of origin; a quantitative analysis of the TransAge survey found a higher level of worry about the pandemic among Italian migrants in Switzerland in comparison to Swiss natives ( Ludwig-Dehm et al., 2023 ). We were therefore interested in investigating whether Italian migrants evoked the COVID-19 situation in Italy when describing their own experiences of wellbeing, but none of our participants organically elicited Italy's situation in their narratives. We subsequently asked participants whether they were impacted in any way by the pandemic in Italy, and responses were heterogeneous. A large part expressed not having been impacted at all, others stated that they were sorry for the high numbers of deaths in Italy and they kept in contact with family, but were not particularly affected. Few of our participants, however, disclosed the emotional suffering they experienced due to Italy's high death rates, as demonstrated by the following quotes:

“I felt tremendous suffering […] I followed a lot, every day I was watching the Italian news. And it was, for me it was just – I don't want to say worse than the war, it was a virtual war, people dying without weapons, people dying without the bombs, without being machine-gunned, but they were dying like flies.” (Giulia, 70, F, Italian migrant)     “Terrible, I felt really bad, I mean I don't know why we got to that point.” (Sara, 78, F, Italian migrant)

Although Italian migrants and Swiss natives lived the pandemic in the same context and both used similar coping strategies during the first confinement period, interviews show that Italian migrants' experiences were slightly more heterogeneous than Swiss natives', with a few migrants expressing feelings of loneliness and emotional anguish, emotions that were absent in Swiss natives' accounts.

5.2.1.3 Experiences of Italian natives

In comparison to Swiss natives and Italian migrants in Switzerland, most Italian natives residing in Italy expressed feelings of worry, sadness, and fear when recounting their lockdown experiences, but most of them coupled their hardships with feelings of acceptance. Tommaso, for example, recounts:

“To hear on television, from the media, that there are deaths and deaths and deaths, obviously the concern is there. The fear, the terror even, of suffering these negative effects.” (Tommaso 84, M, Italian native)

But later, when discussing the lockdown, he continues:

“I stayed peacefully at home with a nice long beard, growing it out. I accepted it, though, because those were the rules. You had to accept them.” (Tommaso, 84, M, Italian native)

Similarly, Paolino couples the dismay brought on by the pandemic lockdown with feelings of acceptance, as well as behaviors aimed at avoiding contagion. He explains:

“The beginning of the pandemic I accepted it begrudgingly, at home, and I stayed at home despite my habits, because having lived a life always on the move – until now I was always around. That thing, the pandemic, I accepted it, and for 3 months I stayed at home, I would only go get some groceries, the bare minimum.” (Paolino, 86, M, Italian native)

In contrast to Swiss natives and Italian migrants, few Italian natives mentioned having turned to hobbies to fill up their time during the first lockdown. Some mentioned the importance of spending time outside, of having a balcony or a garden. Most of them cited phoning friends and family for emotional support, to pass time, and to update each other on their health, and most declared having used the phone for communication more than pre-COVID times. To respect social distancing rules, one participant even used intercom to communicate with family in the same building; she says:

“We used to talk to each other by intercom and by phone, we all live in the same building, so by intercom, by phone we used to talk to each other, and then if somebody went out, they would walk by the kitchen door, which was made of glass, and then we would see each other.” (Rosa, 71, F, Italian native)

Despite the coping strategies employed by Italian natives, their narratives of the lockdown presented an overarching theme of dejection, which was less present in Italian migrants' experiences and nearly absent in those of the Swiss natives in our sample.

5.2.2 Wellbeing after 2 years of the COVID-19 pandemic: the role of social contacts

Notwithstanding the different narratives of wellbeing among the three groups, the previous sections indicate that everyone inevitably experienced a decrease in physical social contacts resulting from the COVID-19 containment policies. Given the importance of social networks for individuals' wellbeing ( Helliwell and Putnam, 2004 ; Elgar et al., 2011 ; Amati et al., 2018 ), we aimed to inquire how social distancing regulations impacted participants' perceived wellbeing in the 2 years after the onset of the pandemic.

Our interviews reveal heterogeneous responses to social distancing; nonetheless, regardless of the perceived impact on their wellbeing, most participants employed behavior-focused coping strategies aimed at reducing probability of contagion and illness. These strategies consisted of either vaccination for the participant, social distancing habits, or a combination of the two. In some cases, these strategies were successful in supporting participants' experienced wellbeing. In other cases, they preserved one's physical wellbeing at the cost of their subjective wellbeing.

In the next sections, we explore how each of the three groups was impacted by decreased social contacts, how these sentiments developed throughout the pandemic, and how participants employed the above-mentioned coping strategies at the time of interview.

5.2.2.1 Experiences of Swiss natives

Just like the lockdown did not seem to negatively impact most Swiss older adults in our study, neither did the imposed social distancing measures and related decrease in social contacts. Most of them experienced a slight change of social habits, which entailed seeing friends and family less frequently during the previous 2 years in comparison to pre-COVID times. However, these changes did not have a consequential negative impact for most of our Swiss participants. Social distancing was often described as bothersome or strange, but easily managed. Martin, for example, states:

“Yeah, [the pandemic] restricts our freedom to see – as I'm a pretty tactile person, it's true that it changes me a little bit. Friends, I kiss them less. That's what affects me a little bit more – I have to be less, much less tactile than I was with everyone, to give kisses to the left and to the right. Well, it's a bit weird.” (Martin, 75, Swiss Native)

This quote represents the sentiments expressed by most Swiss natives: they were not completely unaffected, but they were able to adapt to the changes in social habits without important repercussions for their wellbeing. At the time of interview, nearly 2 years after the pandemic onset, most Swiss older adults explained their social habits were similar to their pre-pandemic habits, but they also adopted strategies to be able to fulfill their social desires while avoiding contagion or severe illness. Most Swiss participants mentioned being vaccinated and expressed the importance of listening to scientists' advice on the preventative measures to take. These strategies helped them adjust their behaviors accordingly and feel more protected. Martin, for instance, has resumed seeing friends, but only under certain self-imposed rules. He explains,

“If we see each other, we are all vaccinated. We are not safe from catching it but at least we are less likely to get sick. And then, we avoid those who don't want to be vaccinated or those who are not vaccinated.” (Martin, 75, Swiss native)

However, one Swiss participant shared the negative experiences that followed him and his wife throughout the course of the pandemic. During the lockdown, Gianni expressed being “stuck at home,” and this lack of freedom and decreased social contacts persisted until the time of the interview, 2 years later. He says,

“Now with these problems of…the danger of contagion, and so it makes us less, less mobile, less free to live, right? Basically now, even though the lockdown has not been declared, we try to go out as little as possible, not to mingle with people so we don't get infected.” (Gianni, M, 88, Swiss native)

While most Swiss older adults were able to resume their social lives by adopting behaviors to avoid illness, the social distancing measured employed by Gianni – the oldest among our Swiss participants – allow him to preserve his physical wellbeing at the cost of his subjective wellbeing.

5.2.2.2 Experiences of Italian migrants in Switzerland

In comparison to older Swiss natives, the perceived impact of social distancing measures was more heterogeneous among Italian migrants. At the time of interview, only a minority of participants said they had resumed their pre-pandemic social habits, although most slowly started seeing small groups of friends again. Like in Gianni's case, for many Italian migrants, the social distancing strategies adopted to preserve their physical wellbeing had negative repercussions on their experienced wellbeing. One participant, for example, shared that the fear of contagion remained even after containment restrictions were eased, and his personal relationships suffered. He explains,

“I lost touch with friends, you couldn't get together, you couldn't go shopping, the only thing I could do was go [walk] in the forest. Then, even when the restrictions were eased, it had affected me so much that it was hard to get together. When we got together […] we had a drink and then left. There was always that fear between us.” (Giacomo, 68, M, Italian migrant)

Giacomo looks back at his life before the pandemic with melancholy, but he also elicits the importance of acceptance and reframing one's mindset to surmount the situation. He shares:

“[Before COVID-19] we used to get together on Friday nights, play cards, drink, smoke, and for 2 years we haven't done it and I don't think we're going to start again. It's difficult because people have become distrustful, we've been wounded and we're licking our wounds. Let's put it this way. You have to get over it, direct your life differently and move on. I don't want to stay at home waiting for death.” (Giacomo, 68, M).

Although some participants were wary of resuming social activities at the time of interview, most slowly started seeing friends again while continuing to employ social distancing measures. Giulia, for instance, explains:

“[Before the pandemic] maybe we went to the restaurant once a month, or once every 2 months. But that was a lot. But we haven't done this anymore, and I didn't – and we don't even feel like doing it anymore. Now if we go to a restaurant, we go at noon…and we stand outside on the terrace because we keep being careful.” (Giulia, 70, F, Italian migrant)

Despite the slow return to a social life and the continued safety measures employed, the pandemic had a long-lasting impact on the wellbeing of most Italian older migrants, as evidenced by the following excerpts:

“I feel insecure, maybe because of the pandemic, because of the war that's going on 2 […] I feel insecure and I tell myself I don't need this […] Insecure in the sense that I say, enough of the pandemic; insecure not physically, but in the sense that it destabilizes me [mentally] […] In the sense that I used to be able to imagine the following years and now I can't.” (Sara, 78, F, Italian migrant)     “It's 2 years that I lost and that I cannot get back. […] I lost 2 years that I won't get back. I don't even know if I'll be able to – to feel better.” (Giulia, 70, F, Italian migrant).

5.2.2.3 Experiences of Italian natives in Italy

The perceived impact of the social distancing measures was notably detrimental for the experienced wellbeing of Italian natives in Italy. Most cited the lack of social contacts as the primary difficulty faced throughout the pandemic. For many, the fear instilled by the pandemic prevented them from resuming their social activities at the time of interview, despite most participants being vaccinated. This engendered feelings of sadness, anxiety, and loneliness among many Italian participants, as evidence by the following quotes:

“What I dislike is not being able to have company, because I'm all about friendships, company, laughter, and I don't like loneliness. […Before the pandemic] we used to organize trips with an association, so we would spend 15 days together, and every 2 months we would meet in an institution and spend the day together, we would eat together. With girlfriends, we would go out and take a walk in the countryside when we had nice days, and so I miss all of that now.” (Martina, 84, F, Italian native)     “Now the fact of going out and putting the mask on […], continually having to disinfect your hands when you go out, when you go get groceries, having to be careful not to get too close to people, [hoping] that in stores there aren't too many people. These – this anxiety that it gives you, that as long as you are at home, it's different. But when you go out for necessities, or go to the hospital for a visit – in short, it's anxiety, that's it. You try to – every person you meet seems to be an enemy.” (Rosa, 72, F, Italian Native)     “I have a lot of fear, really a lot, and this has prevented me from going out and also from having a social life. My social life has almost disappeared, because partly the fear, partly my age, and so the result is that while before I used to go to concerts, I used to go to the movies, now we have – my husband and I – we have canceled everything, we don't go anymore, and so there is a lot of sadness.” (Alice, 75, F, Italian native)

Although some expressed feeling safer due to the vaccine, the fear induced by the virus was still present 2 years following the pandemic onset. Many Italian natives described the continued use of their phones to communicate with friends and family – more so than during pre-pandemic times – and this kept them company. Nonetheless, most expressed that while at the beginning they tried to accept the circumstances, the pandemic had started to weigh on them and negatively influence their wellbeing. Only one Italian native shared that the changes in social habits did not have a substantial impact on his wellbeing:

“[The pandemic] did not substantially change my life, nor my family's. Of course, there were occasions when we would have liked – during the holidays, for example – to spend more time with friends. We gave this up, and we think and hope that it was accepted by our friends. In any case, this withdrawal was nothing out the ordinary, so it was nothing irrational. Let's say that it did not affect our life, our wellbeing.” (Lorenzo, 74, M, Italian native)

Yet, even for a person like Lorenzo who estimates that his wellbeing was not lowered by the pandemic, his social habits have changed, which was observed for most of the Italian natives in Italy.

6 Discussion

The objective of this study was to provide insight into older adults' experiences of wellbeing as well as the coping strategies employed to overcome difficulties brought about by the pandemic, in particular social distancing. Our contribution to the existing literature is 4-fold: (1) we explored older adults' lived experiences not only through their recollection of the first months of the pandemic, but also through their narratives of wellbeing and coping 2 years after the pandemic onset, (2) we analyzed the experiences of older migrants, an underrepresented population in wellbeing and COVID-19-related research, (3) we compared the experiences of two groups – Swiss natives and Italian migrants – who lived the pandemic in the same context, and (4) we compared the experiences of older adults who were subject to strict containment measures – as was the case of Italian natives – to those of adults who benefitted from more lax restrictions.

The following section discusses the results of the qualitative interviews, as well as the study limitations and implications for future policy.

While many of our interviews highlight the negative consequences of the pandemic for older adults' wellbeing in Switzerland and Italy, they also emphasize the heterogeneity of older individuals' experiences, as well as their ability to adapt and cope with stressful situations. Swiss natives and Italian migrants lived the pandemic in the same context, one that did not impose strong stay-at-home order and allowed for a certain freedom of movement. Yet, we found pronounced differences in their descriptions of wellbeing, both in the narratives concerning the first lockdown in 2020, and in the narratives addressing the following years, until time of interview.

Most Swiss natives presented positive accounts of the lockdown period; their descriptions were often coupled with coping strategies they employed to address the COVID-19 containment measures. Consistently with previous studies on coping during the pandemic, in the first months of the pandemic Swiss older adults relied on hobbies to keep busy, closeness to nature, acceptance of the sanitary situation, and cognitive strategies to find the silver lining of living through a world-wide crisis ( Finlay et al., 2021 ; Fuller and Huseth-Zosel, 2021 ; Whitehead and Torossian, 2021 ; Brooks et al., 2022 ; Bustamante et al., 2022 ; Mau et al., 2022 ). Most participants described their wellbeing as unaffected even at the time of interview, 2 years after the pandemic onset. Although they described the inevitable decrease in physical contacts as bothersome, most were able to adopt behavioral strategies that involved vaccination and continued social distancing measures that kept them safe while fulfilling their social needs.

Even though Italian migrants experienced the pandemic in the same context as Swiss natives, their accounts of the lockdown and the following years were more heterogeneous. During the first months of the pandemic, they used coping strategies like those of the Swiss natives: they spent their time in nature, kept busy through hobbies, and they, too, positively referred to the freedom they felt due to Switzerland's relaxed containment measures. At this time, only some participants expressed feelings of sadness and loneliness. However, when reflecting on the entirety of the previous 2 years, most participants shared the negative impact of the pandemic on their wellbeing. Although many slowly resumed social activities at the time of interview, they evoked a continued sense of fear, distrust, and dejection. Many of their interviews demonstrated that the social distancing behaviors that allowed them to keep themselves physically safe diminished their wellbeing.

Due to the qualitative nature of this article, it is not possible to firmly assert that the different experiences of wellbeing among Swiss natives and Italian migrants are due to inequalities in reserves. However, we can posit that, at least for some Italian migrants in Switzerland, their ability to cope with the pandemic may have been partly influenced by their lower level of reserves in comparison to those of Swiss natives.

Most Italian migrants in our study migrated to Switzerland in the 1960s and 1970s, as part of the wave of labor migrants who moved from regions of Italy that lacked economic opportunities ( Bolzman and Vagni, 2018 ; Dones and Ciobanu, 2022 ). Quantitative studies have revealed that, compared to older Swiss natives, older Italian migrants in Switzerland have lower education levels, report themselves in worse health, and generally occupied lower-skilled jobs ( Bolzman and Vagni, 2018 ). For many, the migration to Switzerland as labor workers was followed by a lack of opportunities to improve their socio-economic circumstances, leaving them in worse situations in comparison to their Swiss counterparts. These disadvantaged conditions may have engendered psychological stresses that may have accumulated over the life course ( Dannefer, 2003 ; Settersten et al., 2020 ), thereby impacting migrants' ability to build the adequate reserves to successfully cope with life shocks.

In our qualitative sample of Italian migrants there is an overrepresentation of highly educated participants and of participants in a comfortable financial situation, as represented by the measure “making ends meet” in Table 1 ( Dones, 2023 ). However, on average they still have lower education levels than Swiss natives. Moreover, independently of current socioeconomic status, most participants spoke of the poverty and lack of jobs they experienced during their youth in Italy, which ultimately led them to migrate. In addition, when reflecting on other hardships encountered during their lifetimes, most cited the difficulties encountered when they migrated: discrimination, having to learn another language, detachment from family in Italy, and getting accustomed to a foreign country. Along with the disadvantaged socioeconomic conditions some participants experienced throughout the lifespan, most experienced migration-related stressors that, accumulated over the life course, may have impacted their capacity to cope with life shocks and with the pandemic in the same way that Swiss natives did. Moreover, the capacity to act in old age is dependent on the life course and the accumulation of reserves ( Settersten et al., 2020 ), making in this case a difference between the older Swiss and older migrants.

Although Italian migrants did employ similar coping mechanisms, for most, these coping strategies were not successful in combatting the negative impact of the pandemic on their experienced wellbeing. This finding is in line with research by Pan et al. (2021) , which revealed that coping strategies like increased telephone contact and increased participation in individual activities did not protect older Chinese migrants against loneliness.

Another possible explanation for the lower wellbeing expressed by Italian migrants compared to Swiss natives relates to transnational practices and attachment to the home country. Although participants did not mention their attachment to Italy when recounting their pandemic experiences, some did share the negative impact the Italian situation had on their wellbeing. Previous research stemming from the TransAge project has revealed that greater attachment to Italy correlates to greater worry about the COVID-19 pandemic ( Ludwig-Dehm et al., 2023 ), which may have thereby impacted Italian migrants' lived experiences. Similarly, we found one case of transnational attachment among Swiss natives. The ties to Barcelona led François to value the confinement situation in Switzerland.

In comparison to older adults residing in Switzerland, older Italian natives expressed more negative emotions and difficulties when describing both the first COVID-19 lockdown and the subsequent years. Most adopted coping strategies like acceptance and increased telephone use for social contact, but the fear brought about by the virus followed them until the time of interview. This prevented most from resuming social activities, despite being vaccinated, and many expressed continued feelings of sadness, loneliness, and anxiety.

When considering the particularly negative experiences of Italian natives in Italy, we cannot propose that these were related to the various types of reserves accumulated through life, as our participants led heterogeneous life-courses. Indeed, there may be a variety of influencing factors that have the potential to affect the wellbeing of older Italian adults. One of these factors could hypothetically relate to the strict confinement measures employed by the Italian government throughout the first 2 years of the pandemic. Research thus far has revealed that countries' stringency of physical distancing regulations was associated with higher incidence of loneliness and depression among older adults ( Atzendorf and Gruber, 2022 ; Mendez-Lopez et al., 2022 ). Additionally, a study on older adults in Italy showed that restrictive measures significantly impacted the quality of life, psychological wellbeing, and mobility of older adults ( Tosato et al., 2022 ). Although no studies have yet been published on the long-term consequences of strict containment measures, our exploratory results could point to the negative impact of such regulations on older adults' experiences of wellbeing. However, this is simply a theoretical proposition and further studies on the subject are needed to firmly establish a correlation between stringency of confinement regulations and wellbeing.

Moreover, Italian natives relied on telephone communication as a coping mechanism more than the other two groups. While staying in touch with family and friends through phone and other media use has been correlated with life satisfaction during the first semi-lockdown in Switzerland ( Dones et al., 2022 ), studies found that non-personal communication does not substitute face-to-face interactions and it is not a protective strategy against loneliness among older adults ( Pan et al., 2021 ; König and Isengard, 2023 ). Further research should thus address the effectiveness of different coping strategies in times of crisis.

6.1 Limitations, strengths, and suggestions for future research

This study does not come without limitations. Due to the qualitative nature of the research and the relatively small sample size, results cannot be generalized even though saturation of responses was reached. In addition, our study did not explore the experiences of many people who lived alone during the pandemic, a population that might have been particularly at risk of social isolation. Similarly, there is a possibility that older adults with lower levels of wellbeing may not have been willing to participate to the research, although some research participants shared their difficulties and negative experiences of the pandemic. Lastly, to be able to better understand the role of reserves in older adults' experiences of the pandemic, longitudinal, quantitative data would be necessary.

Nonetheless, this article sheds light on several aspects. First, despite the homogeneous representation of older adults as frail and vulnerable ( Petretto and Pili, 2020 ; Ayalon et al., 2021 ; Maggiori et al., 2022 ), the pandemic impact on wellbeing is not the same for all older adults, as demonstrated by emerging studies ( Wettstein et al., 2022a , b ) and by the different experiences of this article's older populations. Second, despite the employment of coping strategies used by all participants, their effectiveness in mediating the long-term impact of the pandemic on experiences of wellbeing differed among groups. Third, the long-term impact of the pandemic and the various containment strategies needs further examination. As the case of Italian migrants in Switzerland shows, some older migrants experienced the beginning of the pandemic in quite positive ways, but their narratives of their situation 2 years after the pandemic onset showed an overall negative effect on their wellbeing.

The share of older adults in Europe continues to increase ( Eurostat, 2023 ), as does the share of older migrants ( UNDESA, 2020 ). The advancements of the last few decades have reduced the dependence of older adults and have increased life expectancy. At the same time, social inequalities and inter-individual diversity make of today's older adults an increasingly heterogeneous group ( Oris et al., 2020 ). The consideration of this heterogeneity should be at the core of not only scientific research, but also of policy interventions, as grouping all older adults under the “vulnerable and frail” umbrella propagates against narratives that can lead to increased psychological distress and negative self-perceptions of aging ( Losada-Baltar et al., 2021 ; Derrer-Merk et al., 2022a , b ).

To account for the diversity in older adults' lives, research on the long-term impact of the pandemic should adopt a life-course approach to further analyze how differing trajectories engender situations of resilience or vulnerability. Given the increase of share of older migrants, their underrepresentation in COVID-19 and wellbeing research, and the possible long-term effects of having a migration background, special consideration should be allotted to them. Moreover, studies should further address the effectiveness of coping strategies among different populations. Lastly, in cases of future health crises, governments should have an increased regard for the negative consequences of stringent confinement measures, as social isolation and physical inactivity among older adults are correlated with increased hospitalization, depression, cognitive impairment, and reduced quality of life ( Cacioppo et al., 2010 ; Cacioppo and Cacioppo, 2014 ; Ozemek et al., 2019 ).

Data availability statement

The datasets presented in this article are not readily available because the qualitative interviews analyzed in this study are not publicly available. For now, they are available from RC on reasonable request. Requests to access the datasets should be directed to RC, oana.ciobanu@hetsl.ch .

Ethics statement

The studies involving humans were approved by the Ethics Committee of the Faculty of Social Sciences of the University of Geneva. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required from the participants or the participants' legal guardians/next of kin because participation in the study was voluntary, and all participants gave oral consent to be interviewed and recorded.

Author contributions

ID drafted the interview guidelines, carried out the data collection and analysis, and was the major contributor in writing the manuscript. RC supervised the project, reviewed and approved the interview guidelines, provided article references, read parts of the interviews, and contributed to the discussion and conclusion. All authors read and approved the final manuscript.

This work was funded by the Swiss National Science Foundation through the Professorship Grant “Transnational Aging among Older Migrants and Natives: A Strategy to Overcome Vulnerability” (Grant Number PP00P1_179077/1).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

1. ^ Of these phone interviews, one was done through WhatsApp audio, the rest through the regular phone line.

2. ^ The participant is referring to the war between Russia and Ukraine, which had just begun at the time of interview.

Aldea, N. (2022). Mortality impact of the COVID-19 epidemic on immigrant populations in Spain. SSM Pop. Health 20:101291. doi: 10.1016/j.ssmph.2022.101291

PubMed Abstract | Crossref Full Text | Google Scholar

Aldwin, C. M., and Revenson, T. A. (1987). Does coping help? A reexamination of the relation between coping and mental health. J. Pers. Soc. Psychol. 53, 337–348. doi: 10.1037/0022-3514.53.2.337

Aldwin, C. M., and Yancura, L. A. (2004). “Coping and health: a comparison of the stress and trauma literatures,” in Trauma and Health: Physical Health Consequences of Exposure to Extreme Stress , eds P. P. Schnurr and B. L. Green (London: American Psychological Association), 99–125.

Google Scholar

Amanto, A. (2022). Italy Ends COVID-19 State of Emergency, Curbs to be Lifted Gradually. Reuters . Available online at: https://www.reuters.com/world/europe/italy-ends-covid-19-state-emergency-curbs-be-lifted-gradually-2022-04-01/ (accessed April 1, 2022).

Amati, V., Meggiolaro, S., Rivellini, G., and Zaccarin, S. (2018). Social relations and life satisfaction: the role of friends. Genus 74, 1–18. doi: 10.1186/s41118-018-0032-z

Atzendorf, J., and Gruber, S. (2022). Depression and loneliness of older adults in Europe and Israel after the first wave of COVID-19. Eur. J. Ageing 19, 849–861. doi: 10.1007/s10433-021-00640-8

Ayalon, L., Chasteen, A., Diehl, M., Levy, B. R., Neupert, S. D., Rothermund, K., et al. (2021). Aging in times of the COVID-19 pandemic: avoiding ageism and fostering intergenerational solidarity. The J. Gerontol. Series B 76, e49–e52. doi: 10.1093/geronb/gbaa051

Bajaj, V., Gadi, N., Spihlman, A. P., Wu, S. C., Choi, C. H., Moulton, V. R., et al. (2021). Aging, immunity, and COVID-19: How age influences the host immune response to coronavirus infections? Front. Physiol. 11:571416. doi: 10.3389/fphys.2020.571416

Bartels, M. (2015). Genetics of wellbeing and its components satisfaction with life, happiness, and quality of life: a review and meta-analysis of heritability studies. Behav. Genetics 45, 137–156. doi: 10.1007/s10519-015-9713-y

Bartram, D. (2012). Elements of a sociological contribution to happiness studies. Sociol. Compass 6, 644–656. doi: 10.1111/j.1751-9020.2012.00483.x

Crossref Full Text | Google Scholar

Biggs, A., Brough, P., and Drummond, S. (2017). “Lazarus and Folkman's psychological stress and coping theory,” in The Handbook of Stress and Health , eds C. L. Cooper and J. Campbell Quick (London: John Wiley and Sons, Ltd),349–364.

Birditt, K. S., Turkelson, A., Fingerman, K. L., Polenick, C. A., and Oya, A. (2021). Age differences in stress, life changes, and social ties during the COVID-19 pandemic: implications for psychological well-being. The Gerontol. Cite 61, 205–216. doi: 10.1093/geront/gnaa204

Bolzman, C., Poncioni-Derigo, R., Vial, M., and Fibbi, R. (2004). Older labour migrants' well being in Europe: the case of Switzerland. Ageing Soc. 24, 411–429. doi: 10.1017/S0144686X03001557

Bolzman, C., and Vagni, G. (2018). “‘And we are still here': Life courses and life conditions of Italian, Spanish and Portuguese retirees in Switzerland,” in Gender, Family, and Adaptation of Migrants in Europe , eds I. Vlase and B. Voicu (New York, NY: Palgrave Macmillan), 67–89.

Bosa, I., Castelli, A., Castelli, M., Ciani, O., Compagni, A., Galizzi, M. M., et al. (2021). Response to COVID-19: was Italy (un)prepared? Health Econ. Policy Law 17, 1–13. doi: 10.1017/S1744133121000141

Brooks, E., Mohammadi, S., Mortenson, W., Ben, B. C. L., Tsukura, C., Rash, I., et al. (2022). ‘Make the most of the situation'. Older adults' experiences during COVID-19: a longitudinal, qualitative study. J. Appl. Gerontol. 41, 2205–2213. doi: 10.1177/07334648221105062

Bull, M. (2021). The Italian government response to COVID-19 and the making of a prime minister. Contempo. Italian Polit. 13, 149–165. doi: 10.1080/23248823.2021.1914453

Bustamante, G., Guzman, V., Kobayashi, L. C., and Finlay, J. (2022). Mental health and well-being in times of COVID-19: a mixed-methods study of the role of neighborhood parks, outdoor spaces, and nature among US older adults. Health Place 76:102813. doi: 10.1016/j.healthplace.2022.102813

Cacioppo, J. T., and Cacioppo, S. (2014). Older adults reporting social isolation or loneliness show poorer cognitive function 4 years later. Evid. Based Nurs. 17, 59–60. doi: 10.1136/eb-2013-101379

Cacioppo, J. T., Hawkley, L. C., and Thisted, R. A. (2010). Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the chicago health, aging, and social relations study. Psychol. Aging 25, 453–463. doi: 10.1037/a0017216

Canevelli, M., Palmieri, L., Raparelli, V., Punzo, O., Donfrancesco, C., Noce, C., et al. (2020). COVID-19 mortality among migrants living in Italy. Ann. Ist. Super Sanità 56, 373–377. doi: 10.4415/ANN_20_03_16

Carstensen, L. L. (2021). Socioemotional selectivity theory: the role of perceived endings in human motivation. The Gerontol. Cite 61, 1188–1196. doi: 10.1093/geront/gnab116

Carstensen, L. L., Shavit, Y. Z., and Barnes, J. T. (2020). Age advantages in emotional experience persist even under threat from the COVID-19 pandemic. Psychol. Sci. 31, 1374–1385. doi: 10.1177/0956797620967261

Carver, C. (2013). “Coping,” in Encyclopedia of Behavioral Medicine , eds M. D. Gellman and J. R. Turner (New York, NY: Springer New York), 496–500.

Ciobanu, R. O., and Ludwig-Dehm, S. M. (2020). Life in limbo: old-age transnationalism. The Gerontol. 60, 322–330. doi: 10.1093/geront/gnz166

Cipolletta, S., and Gris, F. (2021). Older people's lived perspectives of social isolation during the first wave of the COVID-19 pandemic in Italy. Public Health 18:832. doi: 10.3390/ijerph182211832

Clark, A. E. (2011). Income and happiness: Getting the debate straight. Appl. Res. Q. Life 6, 253–263. doi: 10.1007/s11482-011-9150-x

Clark, A. E., Flèche, S., Layard, R., Powdthavee, N., and Ward, G. (2018). The Origins of Happiness (NED-New) . Princeton, NJ: Princeton University Pres.

Clark, A. E., Frijters, P., and Shields, M. A. (2008). Relative income, happiness, and utility: An explanation for the Easterlin paradox and other puzzles. J. Econ. Lit. 46, 95–144. doi: 10.1257/jel.46.1.95

Clegg, A., Young, J., Iliffe, S., Rikkert, M. O., and Rockwood, K. (2013). Frailty in elderly people. The Lancet 381, 752–762. doi: 10.1016/S0140-6736(12)62167-9

Cohn-Schwartz, E., Vitman-Schorr, A., and Khalaila, R. (2022). Physical distancing is related to fewer electronic and in-person contacts and to increased loneliness during the COVID-19 pandemic among older Europeans. Q. Life Res. 31, 1033–1042. doi: 10.1007/s11136-021-02949-4

Cullati, S., Kliegel, M., and Widmer, E. (2018). Development of reserves over the life course and onset of vulnerability in later life. Nat. Hum. Behav. 2, 551–558. doi: 10.1038/s41562-018-0395-3

Dadras, O., SeyedAlinaghi, S., Karimi, A., Shamsabadi, A., Qaderi, K., Ramezani, M., et al. (2022). COVID-19 mortality and its predictors in the elderly: A systematic review. Health Sci. Rep. 5:657. doi: 10.1002/hsr2.657

Dannefer, D. (2003). Cumulative advantage/disadvantage and the life course: cross-fertilizing age and social science theory. The J. Gerontol. Series B Psychol. Sci. Soc. Sci. 58, S327–S337. doi: 10.1093/geronb/58.6.S327

De Jong, H. (2015). “Living standards in a modernizing world - A long-run perspective on material wellbeing and human development,” in Global Handbook of Quality of Life , eds W. Glatzer, L. Camfield, V. Møller, and M. Rojas (Cham: Springer), 45–74.

Deaton, A. (2008). Income, health, and well-being around the world: evidence from the Gallup World Poll. J. Econ. Persp. 22, 53–72. doi: 10.1257/jep.22.2.53

Delle Fave, A., Brdar, I., Freire, T., Vella-Brodrick, D., and Wissing, M. (2011). The eudaimonic and hedonic components of happiness: qualitative and quantitative findings. Soc. Indic. Res. 100, 185–207. doi: 10.1007/s11205-010-9632-5

Derrer-Merk, E., Ferson, S., Mannis, A., Bentall, R. P., and Bennett, K. M. (2022a). Belongingness challenged: exploring the impact on older adults during the COVID-19 pandemic. PLoS ONE 17, 1–19. doi: 10.1371/journal.pone.0276561

Derrer-Merk, E., Reyes-Rodriguez, M., Salazar, A. M., Guevara, M., Rodríguez, G., Fonseca, A. M., et al. (2022b). Is protecting older adults from COVID-19 ageism? A comparative cross-cultural constructive grounded theory from the United Kingdom and Colombia. J. Soc. Issues 78, 900–923. doi: 10.1111/josi.12538

Diener, E. (2012). New findings and future directions for subjective well-being research. Am. Psychol. 67, 590–597. doi: 10.1037/a0029541

Diener, E., Emmons, R. A., Larsen, R. J., and Griffin, S. (1985). The satisfaction with life scale. J. Pers. Assess. 49, 71–75. doi: 10.1207/s15327752jpa4901_13

Dones, I. (2023). Life satisfaction among Italian migrants, Italian stayers, and Swiss natives: who fares better? Comp. Pop. Stu. 48, 457–492. doi: 10.12765/CPoS-2023-18

Dones, I., and Ciobanu, R. O. (2022). Older migrants' life satisfaction. GeroPsych 35, 55–66. doi: 10.1024/1662-9647/a000288

Dones, I., Ciobanu, R. O., and Baeriswyl, M. (2022). (Im)mobilities and life satisfaction in times of COVID-19: THE case of older persons in Switzerland. Int. Health Trends Persp. 2, 35–50. doi: 10.32920/ihtp.v2i1.1590

Donizzetti, A. R., and Capone, V. (2023). Ageism and the pandemic: risk and protective factors of well-being in older people. Geriatrics 8:14. doi: 10.3390/geriatrics8010014

Elgar, F. J., Davis, C. G., Wohl, M. J., Trites, S. J., Zelenski, J. M., Martin, M. S., et al. (2011). Social capital, health and life satisfaction in 50 countries. Health Place 17, 1044–1053. doi: 10.1016/j.healthplace.2011.06.010

E. M Janssen, J. H. M., Nieuwboer, M. S., Olde Rikkert, M. G. M., and Peeters, G. M. E. E. (2022). The psychosocial adaptability of independently living older adults to COVID-19 related social isolation in the Netherlands: a qualitative study. Health Soc. Care Commun. 30, e67–e74. doi: 10.1111/hsc.13436

Eurostat (2023). Population Structure and Ageing . Available online at: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Population_structure_and_ageing (accessed May 03, 2023).

Facal, D., Rodríguez-González, R., Martínez-Santos, A. E., and Gandoy-Crego, M. (2022). Positive and negative feelings among spanish young–old and old–old during the lockdown of the COVID-19 first wave. Clin. Gerontol. 45, 31–35. doi: 10.1080/07317115.2021.1929633

Falvo, I., Zufferey, M. C., Albanese, E., and Fadda, M. (2021). Lived experiences of older adults during the first COVID-19 lockdown: a qualitative study. PLoS ONE 16, 1–18. doi: 10.1371/journal.pone.0252101

Ferrante, P. (2022). The first 2 years of COVID-19 in Italy: incidence, lethality, and health policies. Front. Pub. Health 10:743. doi: 10.3389/fpubh.2022.986743

Finlay, J. M., Kler, J. S., O'Shea, B. Q., Eastman, M. R., Vinson, Y. R., Kobayashi, L. C., et al. (2021). Coping during the COVID-19 pandemic: a qualitative study of older adults across the United States. Front. Pub. Health 9, 1–12. doi: 10.3389/fpubh.2021.643807

Fiocco, A. J., Gryspeerdt, C., and Franco, G. (2021). Stress and adjustment during the COVID-19 pandemic: a qualitative study on the lived experience of canadian older adults. Int. J. Environ. Res. Pub. Health 18:24. doi: 10.3390/ijerph182412922

FOPH (2022). Coronavirus: Federal Council to Lift Measures – Mask Requirement on Public Transport and in Healthcare Institutions and Isolation in the Event of Illness to Remain Until End of March. Available online at: https://www.bag.admin.ch/bag/en/home/das-bag/aktuell/medienmitteilungen.msg-id-87216.html (accessed April 27, 2023).

Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., et al. (2001). Frailty in older adults: evidence for a phenotype. J. Geront. Med. Sci. 56:545770. doi: 10.1093/gerona/56.3.M146

FSO (2020). “ Foreign Population.” Federal Statistical Office . Available online at: https://www.bfs.admin.ch/bfs/en/home/statistics/population/migration-integration/foreign.html (accessed January 13, 2023).

Fuller, H. R., and Huseth-Zosel, A. (2021). Lessons in resilience: initial coping among older adults during the COVID-19 pandemic. The Gerontol. Cite Gerontol. 61, 114–125. doi: 10.1093/geront/gnaa170

Gallè, F., Sabella, E. A., Roma, P., Ferracuti, S., Molin, D., Diella, G., et al. (2021). Knowledge and lifestyle behaviors related to COVID-19 pandemic in people over 65 years old from southern Italy. Int. J. Environ. Res. Pub. Health 18:10872. doi: 10.3390/ijerph182010872

Galobardes, B., Lynch, J., and Smith, G. D. (2007). Measuring socioeconomic position in health research. Br. Med. Bullet . 82, 21–37. doi: 10.1093/bmb/ldm001

Garner, I. W., Varey, S., Navarro-Pardo, E., Marr, C., and Holland, C. A. (2022). An observational cohort study of longitudinal impacts on frailty and well-being of COVID-19 lockdowns in older adults in England and Spain. Health Soc. Care Commun. 30, e2905–e2916. doi: 10.1111/hsc.13735

Gonçalves, A. R., Barcelos, J. L. M., Duarte, A. P., Lucchetti, G., Gonçalves, D. R., Silva e Dutra, F. C. M., et al. (2022). Perceptions, feelings, and the routine of older adults during the isolation period caused by the COVID-19 pandemic: a qualitative study in four countries. Aging Mental Health 26, 911–918. doi: 10.1080/13607863.2021.1891198

Grundy, E. (2006). Ageing and vulnerable elderly people: european perspectives. Ageing Soc. 26, 105–134. doi: 10.1017/S0144686X05004484

Guzman, V., Doyle, D., Foley, R., Craven, P., Crowe, N., Wilson, P., et al. (2023). Socio-ecological determinants of older people's mental health and wellbeing during the COVID-19 pandemic: a qualitative analysis within the Irish context. Front. Pub. Health 12:1148758. doi: 10.3389/fpubh.2023.1148758

Helliwell, J. F. (2003). How's life? Combining individual and national variables to explain subjective well-being. Econ. Modell. 20, 331–360. doi: 10.1016/S0264-9993(02)00057-3

Helliwell, J. F., and Putnam, R. D. (2004). The social context of well-being. Philos. Trans. Royal Soc. London Series Biol. Sci. 359, 1435–1446. doi: 10.1098/rstb.2004.1522

Hiscott, J., Alexandridi, M., Muscolini, M., Tassone, E., Palermo, E., Soultsioti, M., et al. (2020). The global impact of the coronavirus pandemic. Cytokine Growth Factor Rev. 53, 1–9. doi: 10.1016/j.cytogfr.2020.05.010

Holaday, L. W., Oladele, C. R., Miller, S. M., Dueñas, M. I., Roy, B., Ross, J. S., et al. (2021). Loneliness, sadness, and feelings of social disconnection in older adults during the COVID-19 pandemic. J. Am. Geriatr. Soc. 70, 329–340. doi: 10.1111/jgs.17599

Jiang, D. (2020). Perceived stress and daily well-being during the COVID-19 outbreak: the moderating role of age. Front. Psychol. 11:571873. doi: 10.3389/fpsyg.2020.571873

Jordan, R. E., Adab, P., and Cheng, K. K. (2020). COVID-19: risk factors for severe disease and death. BMJ 12:m1198. doi: 10.1136/bmj.m1198

Khlat, M., Ghosn, W., Guillot, M., Vandentorren, S., Delpierre, C., Desgrées du Loû, A., et al. (2022). Impact of the COVID-19 crisis on the mortality profiles of the foreign-born in France during the first pandemic wave. Soc. Sci. Med. 313:115160. doi: 10.1016/j.socscimed.2022.115160

Klausen, S. H. (2020). Understanding older adults' wellbeing from a philosophical perspective. J. Happiness Stu. 21, 2629–2648. doi: 10.1007/s10902-019-00197-5

Kola, L., Kohrt, B. A., Hanlon, C., Naslund, J. A., Sikander, S., Balaji, M., et al. (2021). COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health. The Lancet Psychiatr. 8, 535–550. doi: 10.1016/S2215-0366(21)00025-0

König, R., and Isengard, B. (2023). Coping with COVID-19: older europeans and the challenges of connectedness and loneliness. Soc. Inclusion 11, 310–323. doi: 10.17645/si.v11i1.6072

Lazarus, R., and Folkman, S. (1984). Stress, Appraisal, and Coping . Cham: Springer.

Losada-Baltar, A., Jiménez-Gonzalo, L., Gallego-Alberto, L., Pedroso-Chaparro, M., Fernandes-Pires, J., and Márquez-González, M. (2021). “We are staying at home.” association of self-perceptions of aging, personal and family resources, and loneliness with psychological distress during the lock-down period of COVID-19. The J. Gerontol. Series B 76, e10–e16. doi: 10.1093/geronb/gbaa048

Luchetti, M., Lee, J. H., Aschwanden, D., Sesker, A., Strickhouser, J. E., Terracciano, A., et al. (2020). The trajectory of loneliness in response to COVID-19. Am. Psychol. 75, 897–908. doi: 10.1037/amp0000690

Ludwig-Dehm, S. M., Dones, I., and Ciobanu, R. O. (2023). Between here and there: comparing the worry about the pandemic between older Italian international migrants and natives in Switzerland. Comp. Migr. Stu. 11, 1–24. doi: 10.1186/s40878-023-00331-6

Luhmann, M., Krasko, J., and Terwiel, S. (2021). “Subjective well-being as a dynamic construct,” in The Handbook of Personality Dynamics and Processes (Amsterdam: Elsevier), 1231–1249.

Macdonald, B., and Hülür, G. (2021). Well-being and loneliness in swiss older adults during the COVID-19 pandemic: the role of social relationships. Gerontologist 61, 240–250. doi: 10.1093/geront/gnaa194

Macleod, S., Tkatch, R., Kraemer, S., Fellows, A., McGinn, M., Schaeffer, J., et al. (2021). COVID-19 era social isolation among older adults. Geriatrics 6, 1–15. doi: 10.3390/geriatrics6020052

Maggiori, C., Dif-Pradalier, M., and Villani, M. (2022). ““Vous êtes à risque, restez à la maison”. Les 65+ face à la COVID-19,” in COVID-19 Les Politiques Sociales à l'épreuve de la Pandémie , eds E. Rosenstein and S. Mimouni (Verlag: Seismo Verlag AG), 273–286.

Mau, M., Fabricius, A. M., and Klausen, S. H. (2022). Keys to well-being in older adults during the COVID-19 pandemic: personality, coping and meaning. Int. J. Q. Stu. Health Well-Being 17:669. doi: 10.1080/17482631.2022.2110669

McKinlay, A. R., Fancourt, D., and Burton, A. (2021). A qualitative study about the mental health and wellbeing of older adults in the UK during the COVID-19 pandemic. BMC Geriatr. 21:439. doi: 10.1186/s12877-021-02367-8

Mendez-Lopez, A., Stuckler, D., McKee, M., Semenza, J. C., and Lazarus, J. V. (2022). The mental health crisis during the COVID-19 pandemic in older adults and the role of physical distancing interventions and social protection measures in 26 European countries. SSM – Pop. Health 17:101017. doi: 10.1016/j.ssmph.2021.101017

Nehring, D., and Hu, Y. (2022). COVID-19, nation-sates and fragile transnationalism. Sociology 56, 183–190. doi: 10.1177/00380385211033729

Neville, S., Wright-St Clair, V., Montayre, J., Adams, J., and Larmer, P. (2018). Promoting Age-Friendly Communities: an Integrative Review of Inclusion for Older Immigrants. Journal of Cross-Cultural Gerontology 33, 427–440. doi: 10.1007/s10823-018-9359-3

Oliveira, M. R., Sudati, I. P., Konzen, V. D. M., de Campos, D., Wibelinger, A. C., Correa, L. M., et al. (2022). COVID-19 and the impact on the physical activity level of elderly people: A systematic review. Exp. Gerontol. 159:111675. doi: 10.1016/j.exger.2021.111675

Oris, M., Ramiro Farinas, D., Pujol Rodríguez, R., and Abellán, A. (2020). “La crise comme révélateur de la position sociale des personnes âgées,” in Le regard des Sciences Sociales , eds F. Gamba, M. Nardone, T. Ricciardi, and S. Cattacin (Geneva: Seismo), 179–191.

O'Shea, B. Q., Finlay, J. M., Kler, J., Joseph, C. A., and Kobayashi, L. C. (2021). Loneliness among US adults aged ≥55 early in the COVID-19 pandemic. Pub. Health Rep. 136, 754–764. doi: 10.1177/00333549211029965

Ozemek, C., Lavie, C. J., and Rognmo, Ø. (2019). Global physical activity levels - Need for intervention. Prog. Cardiovascular Dis. 62, 102–107. doi: 10.1016/j.pcad.2019.02.004

Pan, H., Fokkema, T., Switsers, L., Dury, S., Hoens, S., De Donder, L., et al. (2021). Older Chinese migrants in coronavirus pandemic: exploring risk and protective factors to increased loneliness. Eur. J. Ageing 18, 207–215. doi: 10.1007/s10433-021-00625-7

Petretto, D. R., and Pili, R. (2020). Ageing and COVID-19: What is the role for elderly people? Geriatrics 5:25. doi: 10.3390/geriatrics5020025

Pleninger, R., Streicher, S., and Sturm, J. E. (2022). Do COVID-19 containment measures work? Evidence from Switzerland. Swiss J. Econ. Stat. 158:5. doi: 10.1186/s41937-022-00083-7

Riaño, Y., and Wastl-Walter, D. (2006). Immigration policies, state discourses on foreigners, and the politics of identity in Switzerland. Environ. Plann. A 38, 1693–1713. doi: 10.1068/a37411

Robson, J. P. Jr., and Troutman-Jordan, M. (2014). A concept analysis of cognitive reframing. J. Theor. Constr. Testing 18, 55–59.

Rodney, T., Josiah, N., and Baptiste, D. (2021). Loneliness in the time of COVID-19: Impact on older adults. J. Adv. Nurs. 77:14856. doi: 10.1111/jan.14856

Røysamb, E., Nes, R. B., Czajkowski, N. O., and Vassend, O. (2018). Genetics, personality and wellbeing. A twin study of traits, facets and life satisfaction. Sci. Rep. 8, 1–13. doi: 10.1038/s41598-018-29881-x

Røysamb, E., Nes, R. B., and Vittersø, J. (2014). Well-Being: Heritable and Changeable. Stability of Happiness. Amsterdam: Elsevier, 9–36.

Sager, F., and Mavrot, C. (2020). Switzerland's COVID-19 policy response: consociational crisis management and neo-corporatist reopening. Eur. Policy Anal. 6:293. doi: 10.1002/epa2.1094

Seckman, C. (2023). The impact of COVID-19 on the psychosocial well-being of older adults: a literature review. J. Nurs. Scholarship 55, 97–111. doi: 10.1111/jnu.12824

Segerstrom, S. C., Crosby, P., Witzel, D. D., Kurth, M. L., Choun, S., Aldwin, C. M., et al. (2023). Adaptation to changes in COVID-19 pandemic severity: across older adulthood and time scales. Psychol. Aging . 22:7390 doi: 10.1037/pag0000739

Seifert, A. (2021). Older adults during the COVID-19 pandemic – Forgotten and stigmatized? Int. Soc. Work 64, 275–278. doi: 10.1177/0020872820969779

Seifert, A., and Hassler, B. (2020). Impact of the COVID-19 pandemic on loneliness among older adults. Front. Sociol. 5, 1–6. doi: 10.3389/fsoc.2020.590935

Settersten, R. A., Bernardi, L., Härkönen, J., Antonucci, T. C., Dykstra, P. A., Heckhausen, J., et al. (2020). Understanding the effects of Covid-19 through a life course lens. Adv. Life Course Res. 45:100360. doi: 10.1016/j.alcr.2020.100360

Sidani, S., Northwood, M., Sethi, B., Zhuang, Z. C., and Edhi, K. (2022). Social isolation and loneliness in older immigrants during COVID-19: a scoping review. Int. J. Migr. Health Soc. Care 18, 164–178. doi: 10.1108/IJMHSC-08-2021-0071

SkyTG24 (2020). Coronavirus, dai locali alle Palestre: Tutte le Misure nel Nuovo Dpcm di ottobre . Available online at: https://tg24.sky.it/cronaca/2020/10/25/nuovo-dpcm-conte-ottobre#00 (accessed October 25, 2020).

Sneed, R. S., and Krendl, A. C. (2022). What factors are associated with psychological vulnerability and resiliency among older adults during the COVID-19 pandemic? J. Gerontol. B. Psychol. Sci. Soc. 77, 1–4. doi: 10.1093/geronb/gbac027

Spini, D., Bernardi, L., and Oris, M. (2017). Toward a life course framework for studying vulnerability. Res. Hum. Dev. 14, 5–25. doi: 10.1080/15427609.2016.1268892

Su, Y., Rao, W., Li, M., Caron, G., D'Arcy, C., Meng, X., et al. (2023). Prevalence of loneliness and social isolation among older adults during the COVID-19 pandemic: a systematic review and meta-analysis. Int. Psychogeriatr. 35, 229–241. doi: 10.1017/S1041610222000199

Tosato, M., Ciciarello, F., Zazzara, M. B., Janiri, D., Pais, C., Cacciatore, S., et al. (2022). Lifestyle changes and psychological well-being in older adults during COVID-19 pandemic. Clin. Geriatr. Med. 38, 449–459. doi: 10.1016/j.cger.2022.05.002

UNDESA (2020). International Migrant Stock 2020. United Nations Department of Economic and Social Affairs. Available online at: https://www.un.org/development/desa/pd/content/international-migrant-stock (accessed January 13, 2023).

Van Tilburg, T. G., Steinmetz, S., Stolte, E., Van Der Roest, H., and Vries, D. H. (2021). Loneliness and mental health during the COVID-19 pandemic: a study among dutch older adults. J. Gerontol. B Psychol. Sci. Soc. Sci. 76, 249–255. doi: 10.1093/geronb/gbaa111

Veenhoven, R. (2012). “Happiness: Also known as “life satisfaction” and “subjective well-being,” in Handbook of Social Indicators and Quality of Life Research , eds K. Land, A. Michalos, and M. Sirgy (Cham: Springer Netherlands), 63–77.

PubMed Abstract | Google Scholar

Veenhoven, R. (2017). “Measures of happiness: Which to choose?,” in Metrics of Subjective Well-Being: Limits and Improvements , eds G. Brulé and F. Maggino (Cham: Springer International Publishing), 65–84.

Webb, L. M., and Chen, C. Y. (2022). The COVID-19 pandemic's impact on older adults' mental health: contributing factors, coping strategies, and opportunities for improvement. Int. J. Geriatr. Psychiatr. 37:5647. doi: 10.1002/gps.5647

Wessendorf, S. (2007). ‘Roots migrants': transnationalism and ‘return' among second-generation italians in Switzerland. J. Ethnic Migr. Stu. 33, 1083–1102. doi: 10.1080/13691830701541614

Wettstein, M., Nowossadeck, S., and Vogel, C. (2022a). Well-being trajectories of middle-aged and older adults and the corona pandemic: No “COVID-19 effect” on life satisfaction, but increase in depressive symptoms. Psychol. Aging 37, 175–189. doi: 10.1037/pag0000664

Wettstein, M., Wahl, H.-W., and Schlomann, A. (2022b). The impact of the COVID-19 pandemic on trajectories of well-being of middle-aged and older adults: a multidimensional and multidirectional perspective. J. Happiness Stu. 23, 3577–3604. doi: 10.1007/s10902-022-00552-z

Whitehead, B. R., and Torossian, E. (2021). Older adults' experience of the COVID-19 pandemic: a mixed-methods analysis of stresses and joys. The Gerontol. 61, 36–47. doi: 10.1093/geront/gnaa126

WHO (2018). Health of Older Refugees and Migrants. Geneva: WHO.

WHO (2020). WHO Director-General's Opening Remarks at the Media Briefing on COVID-19 - 11 March 2020 . Available online at: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19 (accessed March 11, 2020).

Widmer, E. (2022). “COVID-19 et développement des vulnérabilités: Entre normes déroutantes et manque de réserves,” in COVID-19 Tome II: Les politiques sociales à l'épreuve de la pandémie , eds E. Rosenstein and S. Mimouni (Geneva: Seismo), 225–240.

Yancura, L. A., and Aldwin, C. M. (2008). Coping and health in older adults. Curr. Psychiatr. Rep. 10, 10–15. doi: 10.1007/s11920-008-0004-7

Zaninotto, P., Iob, E., Demakakos, P., and Steptoe, A. (2022). Immediate and Longer-term changes in the mental health and well-being of older adults in England during the COVID-19 pandemic. JAMA Psychiatr. 79:151. doi: 10.1001/jamapsychiatry.2021.3749

Keywords: migration, coping, subjective wellbeing, health crisis, vulnerability

Citation: Dones I and Ciobanu RO (2024) Older adults' experiences of wellbeing during the COVID-19 pandemic: a comparative qualitative study in Italy and Switzerland. Front. Sociol. 9:1243760. doi: 10.3389/fsoc.2024.1243760

Received: 21 June 2023; Accepted: 15 April 2024; Published: 01 May 2024.

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Copyright © 2024 Dones and Ciobanu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Iuna Dones, iuna.dones@hesge.ch

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Community Series in Mental Illness, Culture, and Society: Dealing with the COVID-19 Pandemic, volume VIII

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Published on 7.5.2024 in Vol 10 (2024)

Health Literacy and Health Care System Confidence as Determinants of Attitudes to Vaccines in France: Representative Cross-Sectional Study

Authors of this article:

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Original Paper

  • Georges Khoury 1 , MPH   ; 
  • Jeremy K Ward 2 , PhD   ; 
  • Julien Mancini 3 , Prof Dr, PhD   ; 
  • Amandine Gagneux-Brunon 4 , MD   ; 
  • Liem Binh Luong Nguyen 1 , MD, PhD  

1 CIC Cochin Pasteur, Hôpital Cochin, Assistance Publique—Hôpitaux de Paris, Paris, France

2 Cermes3, CNRS, INSERM, Université Paris Cité, Paris, France

3 Cancer, Biomedicine & Society Group, APHM, Hop Timone, Public Health Department (BIOSTIC), INSERM, IRD, ISSPAM, SESSTIM, Aix-Marseille University, Marseille, France

4 Centre International de Recherche en Infectiologie, Team GIMAP, Inserm, U1111, CNRS, UMR530, CHU de Saint-Etienne, Saint-Etienne, France

Corresponding Author:

Georges Khoury, MPH

CIC Cochin Pasteur

Hôpital Cochin

Assistance Publique—Hôpitaux de Paris

19 Avenue de la Bourdonnais

Paris, 75007

Phone: 33 0610581889

Email: [email protected]

Background: Health literacy involves individuals’ knowledge, personal skills, and confidence to take action to evaluate and appraise health-related information and improve their health or that of their community.

Objective: This study aimed to analyze the association between health literacy and attitude toward vaccines, adjusted with other factors.

Methods: We used the SLAVACO Wave 3, a survey conducted in December 2021 among a sample of 2022 individuals, representative of the French adult population. We investigated factors associated with the attitude toward vaccines using respondents’ different sociodemographic data, health literacy levels, and the health care system confidence levels using a multinomial logistic regression analysis.

Results: Among the participants, 440.4 (21.8%) were classified as “distrustful of vaccines in general,” 729.2 (36.1%) were “selectively hesitant,” and 852.4 (42.2%) were “nonhesitant.” In our model, the level of health literacy was not statistically different between the “distrustful of vaccines in general” and the “selectively hesitant” ( P =.48), but it was associated with being a “nonhesitant” (adjusted odds ratio [aOR] 1.86, 95% CI 1.25-2.76). The confidence in the health care system was a strong predictor for a “nonhesitant” attitude toward vaccines (aOR 12.4, 95% CI 7.97-19.2). We found a positive correlation of 0.34 ( P <.001) between health literacy and confidence in the health care system, but the interaction term between health literacy and health care system confidence was not significant in our model.

Conclusions: Health literacy was associated with a “nonhesitant” attitude toward vaccines. The findings demonstrated that health literacy and confidence in the health care system are modestly correlated. Therefore, to tackle the subject of vaccine hesitancy, the main focus should be on increasing the population’s confidence and on increasing their health literacy levels or providing vaccine information addressing the needs of less literate citizens.

Introduction

Vaccination is an essential component of primary health care, preventing over 20 potential fatal infectious diseases [ 1 ]. Vaccine hesitancy is defined as the refusal or hesitation in accepting vaccines when immunization services are available [ 2 ]. It has been designated by the World Health Organization [ 3 ] as one of the top 10 challenges in public health, underlining the need to research, understand, and tackle this global issue. It is dynamic and complex, affected by external factors such as time, location, and type of vaccine but also by individual factors such as complacency, convenience, and confidence [ 4 , 5 ]. Vaccine hesitancy is particularly strong in France, which is one of the most vaccine-hesitant countries in the world [ 6 ]. At the same time, France has reached a high level of vaccination coverage against COVID-19 [ 7 ]. During the COVID-19 vaccination campaign, many factors have been found to be strongly correlated with attitudes to vaccination in general and to vaccination against COVID-19, in particular, age, gender, complacency, political opinions, perception of one’s health status, trust in health authorities and professionals, and health literacy [ 8 - 10 ]. The ability of people to understand vaccine-related information as well as their understanding of medicine have focused much of the debates on the rise of vaccine hesitancy [ 11 ]. These observations resonate with the concept of “health literacy.” This term has emerged in the 1970s and refers to the motivation and skills used by individuals to access, understand, evaluate, and apply health information for their own health and that of their family and community; to make judgments and decisions about health care, prevention, and health promotion; and to maintain and promote quality of life throughout [ 12 , 13 ]. Health literacy includes abilities to evaluate and criticize health-related information; it involves a level of knowledge, personal skills, and confidence to take action to improve one’s personal health and the health of one’s community by changing one’s lifestyle and living conditions [ 14 , 15 ]. Low health literacy is directly associated with preventable undesirable health outcomes, including poorer general health, mortality, and inadequate decisions for preventive measures [ 16 , 17 ]. It has also been associated with a higher risk of being “hesitant” rather than “provaccination” [ 18 ].

Because health literacy bears heavily on people’s ability to access medical information and health care providers as well as their treatment of this information, it stands to reason that it constitutes a significant determinant of attitudes to vaccinations. However, very few papers have empirically investigated this relationship, which is far from straightforward [ 19 ]. Indeed, health literacy interplays with the components of the “3C” model, as described earlier.

Most studies assess functional health literacy mainly using tools like S-TOFHLA (Short Test of Functional Health Literacy in Adults), thereby focusing only on the ability to understand medical information [ 20 , 21 ]. This is restrictive compared with more recent definitions of health literacy, which include the ability to discuss and ultimately make decisions to promote one’s health, lacking the use of rigorously validated scales as we will in our research. This study aims to contribute comprehensively to the understanding of the relationship between health literacy and vaccine hesitancy. In this paper, we will not only investigate the role of health literacy but also the importance of trust in the health care system and their combined impact on vaccine hesitancy. By examining these factors simultaneously, we aim to offer a more holistic perspective on the phenomenon of vaccine hesitancy, ultimately contributing to more effective public health interventions and strategies.

Recruitment Procedure and Study Sample

Between December 2 and December 17, 2021, invitations to participate in the study were sent to 25,800 French adults, randomly selected from an digital panel of more than 700,000 respondents (provided by Bilendi [ 22 ]). The self-administered web-based questionnaires, lasting approximately 15 minutes, were completed during this period. Participants received remuneration in the form of points for completing these surveys. Ultimately, participants could exchange the accumulated points for gift cards, further acknowledging their invaluable contributions to the survey. We then used the quota sampling method to finally obtain a study sample of 2022 respondents matching the French mainland adult population in terms of age (18-24, 25-34, 35-49 50-64, 75+ years), sex (male and female), occupation (farmers, craftsmen, executives, intermediate professions, employees, workers, retirees, and other inactives), population size of the area of residence (<2000, 2000-20,000, 20,000-100,000, and >100,000 inhabitants), and region (Alsace, Aquitaine, Auvergne, Burgundy, Brittany, Center, Île-de-France, Languedoc, Nord-Pas-de-Calais, Normandy, Pays de la Loire, and Provence-Alpes-Côte d’Azur). A weighting procedure was applied to further match the sample to these characteristics when the quota was not perfectly met. To do so, we used the raking ratio method using the SAS Calmar macro developed in France by the National Institute of Statistics and Economic Studies.

Data Collected and Outcome

After the participants’ consent was obtained, we collected information on respondents’ sociodemographic characteristics such as age, sex, educational attainment, and income, as well as their attitudes and practices on a number of issues including vaccination, politics, alternative medicine, and trust in various institutions. Our main outcome is the attitude of the French adult population toward vaccines, using a widely recognized typology for assessing attitudes toward vaccines in France [ 23 , 24 ]. We made a typology in 3 categories based on the answers to 5 questions with the same format, asking whether the responders were in favor of (1) vaccines in general, (2) the flu vaccine, (3) the hepatitis B virus (HBV) vaccine, (4) the human papillomavirus (HPV) vaccine, and (5) the measles vaccine. The categories were built as follows:

  • Category 1 (nonhesitant): All respondents who answered favorably to all 5 questions (ie, individuals who are favorable for vaccines in general and 100% accepting all types of vaccines).
  • Category 2 (provaccine but selectively hesitant): All respondents who answered “favorable” to the question on vaccines in general but who answered “unfavorable” or “I do not know” to at least 1 of the 4 questions on specific vaccines. These represent the people who are favorable to vaccines in general but have doubts or reservations about specific vaccines.
  • Category 3 (distrustful of vaccines in general): All respondents who answered “unfavorable” to vaccines in general.

Assessment of Health Literacy Level and Health Care System Confidence Level

We calculated 2 scores: a health literacy score (HLS 19 -Q12) and a confidence score. The health literacy score was based on a series of 12 questions with a 4-point Likert scale on the ability of each participant to understand, evaluate, and make health decisions in their everyday life using a 48-point score ( Multimedia Appendix 1 ). A score between 4 and 48 was obtained summing the 12 responses, with a higher score indicating a higher health literacy level. We divided the population into quartiles for the analysis: “very high” for a score >36, “high” for a score between 32 and 36, “low” for a score between 26 and 31, and “very low” for a score <26. The health care system confidence score was based on a series of 5 questions about the confidence in science, government agencies that monitor health and environmental risks, government, physicians, and drug manufacturers using a 20-point score with a 4-point scale ( Multimedia Appendix 2 ). A higher score indicates a higher confidence level. The confidence levels score was categorized as follows based on a quartile division: “confident” for a score ≥19, “somewhat confident” for a score between 17 and 19, “somewhat not confident” for a score between 13 and 16, and “not confident” for a score <13. To estimate the internal validity of our scores, we calculated the Cronbach coefficient, in which a result of >0.9 for the health literacy score and the confidence score was considered as a strong internal validity criterion.

Statistical Analysis

Participants’ baseline characteristics were described for each level of vaccine hesitancy. We used chi-square test with Rao and Scott’s second-order correction in cross-tabulations, a univariate regression model to select statistically significant variables by a forward stepwise selection method (entry threshold P <.2), and a multinomial logistic regression to investigate factors associated with the attitude of the French adult population toward vaccines using respondents’ different background data, health literacy levels, and confidence levels. Our model was adjusted on gender, age, level of education, income, health care system confidence level, and health literacy level. Because of weighting, frequency counts including decimal points, odds ratios, and adjusted odds ratio (aOR) were reported with 95% CI. We also tested the first-order interaction between health literacy and confidence level to uncover hidden or conditional relationships in data that would not be apparent when looking at individual variables in isolation. A further sensitivity analysis was conducted based on our model excluding health care system confidence.

Pearson correlation tests were used to test the relationship between health literacy and health care system confidence to assess whether there is an association or linear relationship between them, which also provides information about the strength and direction of the association. This test will help us identify whether these 2 factors are positively, negatively, or not significantly associated with each other.

Ethical Considerations

Informed consent to participate in this study (including analyses presented in this paper) was collected before the completion of the questionnaire. Researchers did not have access to identifying data on participants following standard practices for web-based surveys. Participants received points after completing the surveys. Ultimately, participants could exchange all the points they received as gift cards. The methodology of the study was reviewed and approved by the ethical committee of the INSERM (IRB00003888, #21-770).

Characteristics of the Population

In our study population, 208.1 (10.3%) were young adults, 1276.3 (63.1%) were 25-64 years of age, and 537.4 (26.6%) were 64 years and older with a sex ratio of 91 male participants per 100 female participants. Regarding the level of education, 1322.5 (65.4%) achieved secondary education, and 743.4 (36.7%) earned less than €2000 per month (a currency exchange rate of €1=US $1.183 is applicable). Baseline characteristics of the study population, overall and by the level of vaccine hesitancy, are described in Table 1 .

a Chi-square test with Rao and Scott’s second-order correction.

b A currency exchange rate of €1=US $1.183 is applicable.

Pattern of Vaccine Hesitancy in the Population

Among the 2022 participants, 852.4 (42.2%) were “nonhesitant,” 729.2 (36.1%) were “selectively hesitant” (among which, n=678.2, 93% were not favorable to 1 or 2 vaccines), and 440.4 (21.8%) were “distrustful of vaccines in general.” The “nonhesitant” group was older with a higher male or female sex ratio. Regarding health literacy score, the “nonhesitant” group had the highest proportion 275.4 (32.3%) with a “very high” score, whereas the “distrustful of vaccines in general” group had the highest proportion 166.6 (37.8%) with a “very low” score. Regarding confidence scores, the “nonhesitant” group had the highest proportion 346.7 (40.7%) of “confident” (>19/24), whereas the “distrustful of vaccines in general” group had the highest proportion 185.2 (42.1%) of “not confident” (<13/24). Of note, a large majority of “distrustful of vaccines in general” individuals 355.8 (80.8%) belong to either “somewhat not confident” or “not confident” categories.

Factors Associated With Vaccine Hesitancy

We examined our multinomial logistic regression model factors associated with attitude toward vaccination taking the “distrustful of vaccines in general” group as a reference ( Table 2 ). The sex ratio of male and female participants was not significantly different with the “selectively hesitant” group but was higher among the “nonhesitant” with an aOR of 1.43 (95% CI 1.09-1.88). Age was higher in the “selectively hesitant” population, and the aOR varied from 2.72 (95% CI 1.72-4.29) for the 50- to 64-year age group to 4.01 (95% CI 1.94-8.27) for the 75+-year age group. In the “nonhesitant” group, aOR passed from 1.93 (95% CI 1.16-3.20) for the 50- to 64-year age category to 3.28 (95% CI 1.57-6.86) for the 75+-year category. No association was found for the younger age group. The level of education was also associated with vaccine hesitancy: participants having a postgraduate degree yielded an aOR of 2.63 (95% CI 1.58-4.40) in the “selectively hesitant” group and an aOR of 2.21 (95% CI 1.33-3.68) in the “nonhesitant” group, taking the “distrustful of vaccines in general” as reference. Confidence was a strong predictor of the attitude toward vaccination in both categories, with a higher confidence score leading to a higher aOR. In the “selectively hesitant” category, aOR varied from 1.60 (95% CI 1.16-2.20) for “somewhat not confident” level to 4.13 (95% CI 2.64-6.46) for the “confident” level. In the “nonhesitant” group, aOR varied from 2.77 (95% CI 1.91-4.01) for the “somewhat not confident” level to 12.4 (95% CI 7.97-19.2) for the “confident” level. While the health literacy levels did not appear statistically significant in the “selectively hesitant” group, a statistical difference was observed in the “nonhesitant” group compared to the “distrustful of vaccines in general” group: aOR increased from 1.50 (95% CI 1.04-2.16) for the “low” level of health literacy to 1.69 (95% CI 1.14-2.50) for the “high” level of health literacy and eventually 1.86 (95% CI 1.25-2.76) for the “very high” level of health literacy.

a aOR: adjusted odds ratio.

b Values in italics format are statistically significant with a P <.05.

c A currency exchange rate of €1=US $1.183 is applicable.

The robustness of these results was tested by conducting a multivariable regression model for each type of vaccine included in the questionnaire (vaccine in general, flu vaccine, HPV vaccine, HBV vaccine, and measles vaccine) with the same covariables and found that for each vaccine, health care system confidence was highly associated with a positive attitude toward vaccine ( P <.001), but health literacy was no longer associated with a positive attitude toward each vaccine ( P >.05) with no interaction term between these 2 variables ( P >.10). The results of the Pearson correlation coefficient showed a modest positive correlation of 0.34 ( P <.001) between health literacy and the health care system confidence.

To explore these findings, our multivariable regression model for each of the vaccination types listed in the questionnaire (vaccine in general, flu vaccine, HPV vaccine, HBV vaccine, and measles vaccine) showed that in all of the regression models, vaccine acceptance for each of the vaccines mentioned was strongly associated with the confidence level but not with health literacy with no interaction between health literacy and confidence ( P value of interaction >.1). We found a modest correlation (Pearson correlation coefficient=0.34) between health literacy and confidence. Another multinomial logistic regression was performed by removing the health care system confidence indicator from our model ( Table 3 ). In this model, the effect of health literacy on vaccine hesitancy appeared to be significant ( P <.001) with higher aOR.

Principal Findings

This study confirms a relationship between vaccine hesitancy and health literacy in this study sample, representative of the French population, in which only 852.4 (42.2%) are “nonhesitant.” In a regression model looking at factors associated with vaccine hesitancy, we found that higher age, male sex, health care system confidence, health literacy, and educational attainment were independently associated with less vaccine hesitancy. Health care system confidence was notably a strong predictor: a person with the highest level of confidence is 12 times less likely to be “distrustful of vaccines in general” and 4 times less likely to be “selectively hesitant.”

The level of vaccine hesitancy in this study sample is consistent with other studies conducted in France [ 23 , 24 ]. Our regression model confirms the “confidence, complacency, constrain” (so-called “3C”) model developed by the Strategic Advisory Group of Experts on Immunization Working Group [ 2 ]. However, confidence is multileveled: it includes confidence in health care professionals but also in the health care system, and the national state. This study specifically addressed confidence in the health care system. While primary care providers are often among the most trusted, confidence in the state and policy makers can be much more difficult to build or regain. In this study, we found a widespread mistrust of government and the pharmaceutical industry that logically translates into mistrust of vaccines (n=355.8, 80% of the “distrustful of vaccines in general” participants belonged to the nonconfident categories).

We also looked at the role of health literacy in vaccine confidence. A recent systematic review that looked at the association of health literacy with intention to vaccinate and vaccination status found high heterogeneity in the assessment of health literacy, inconsistent results, or a weak association when analyzing 21 papers [ 19 ]. Studies have hypothesized a mediating role of health literacy on the relationship between health care system distrust and vaccine hesitancy [ 25 ], while in other context, researchers studied, for example, the potential mediating effect of trust in one’s physician on the association of health literacy and medication adherence [ 26 ]. This could reflect the fact that health literacy is often associated with other properties that are also likely to affect attitudes to vaccines such as mistrust of actors in vaccination policies, but it could also reflect the paradoxical effect that health literacy is likely to have on attitudes to vaccines. Indeed, health literacy can both help to navigate the health care system and gain access to medical professionals who provide evidence-based information, but it can also favor “doing your own research” and coming across vaccine-critical information. This potentially paradoxical effect of the ability and propensity to look for information regarding health has been well documented by work on the relationship between healthism—the tendency for individuals to exercise control over their own choices in order to maximize their life expectancy—and vaccine hesitancy [ 27 ]. Our results contribute to these reflections. We found that a higher health literacy level is associated with being “nonhesitant,” whereas it was not statistically significant in selective hesitancy when controlling for confidence in health care actors.

The relationship between confidence in the health care system and health literacy was also examined. We found that these 2 factors were independent in our model (no interactions found) but modestly correlated. The correlation between the 2 variables seems to be less strong in France than in other countries. For instance, a cross-sectional survey conducted in Taiwan to measure the association between health literacy and trust in physicians and health care systems with a population of 2199 adults showed that respondents’ level of confidence in medical professionals and the health care system was higher among those with better health literacy [ 28 ]. After adjusting for respondents’ sociodemographic factors, health literacy remained significantly and positively associated with confidence. Our results therefore suggest that literacy in itself might be less important in France compared to trust. This could reflect the fact that distrust of public actors is particularly strong in France. Comparative work could shed light on national differences in the relationship between trust in health care actors and health literacy. The relationship between the 2 is likely to be affected—among other factors—by the organization of health care and how social inequalities are reflected in health. The absence of interaction effect between health literacy and trust in health care actors is also interesting. We could expect that a higher level of literacy combined with a higher distrust of health care actors would favor the tendency to find and appreciate vaccine-critical sources. It is possible that these tendencies are counterbalanced by a greater propensity among the more literate to identify the public signals denouncing the antivaccine rhetoric as antiscientific, which tend to be pervasive in the mainstream media, especially in France [ 29 , 30 ]. One possible avenue of research in future work could be to explore the relationship between health literacy and information-seeking practices on social media. Inspiration could come from research on how political attitudes interact with social media use and with educational attainment in the inception of vaccine attitudes (for reviews of the literature, see [ 31 , 32 ]).

We found that the male sex was associated with the “nonhesitant” group (aOR 1.43, 95% CI 1.09-1.88). These findings confirm that male sex had more often positive attitudes toward vaccines, whereas women are more likely to be hesitant. These findings are in line with previous studies on vaccine hesitancy [ 33 - 35 ].

Level of education and educational attainment were found to be an independent factor on vaccine acceptance after adjusting for health literacy and health care system confidence.

Finally, in our model, the level of income did not appear to be statistically significant with vaccine acceptability. Despite not achieving statistical significance in the multinomial regression model, it is worth noting that the estimated aORs for vaccine hesitancy showed a trend to enhance vaccine acceptance with a salary in the range of €2000-€4000 per month for the “selectively hesitant” group and for a salary of more than €4000 per month for the “nonhesitant” group. These results confirm prior study results, which indicates that families in the lowest income categories in Brazil, which account for one-third of the population, are reported to be the most vaccine hesitant [ 36 ]. Given that those in lower income brackets (income <€1500 per month) make up about 15% of the French population in 2018 [ 37 ] and showed the lowest vaccination acceptance rates (23.05%) and the greatest vaccine hesitancy rates (33.04%) [ 38 ].

Limitations

This study also has several limitations: health literacy is complex. Our questionnaires using close-ended questions may not capture the whole dimensions of this concept. For example, our questionnaire could not separate health literacy from scientific literacy. The same limitation applies for confidence. These limits could only be resolved using qualitative methods that could examine how health literacy and confidence translate in reality with vaccine providers. The second limitation of this study was the recruitment procedure, which uses quota sampling and can lead to more biases than random sampling. However, the frequency of vaccine hesitancy appeared to be consistent with the frequency previously reported in the literature.

Finally, this study has several strengths: the study population was representative of the French population, which has one of the highest vaccine hesitancy rates; we used a validated tool to assess vaccine hesitancy; and the large sample size of this study allows to examine various factors that have been separately associated with vaccine hesitancy in previous studies as well as different vaccines.

Conclusions

Interventions aiming to reduce vaccine hesitancy should prioritize confidence-building measures, which are difficult. Improving health literacy may also help, and public health interventions demonstrated their ability to increase health literacy. We believe that there is a possibility that improving health literacy can also lead to enhanced confidence in the health care system in the long run. Public health campaigns and educational programs should enhance health literacy, while health care providers engage in open, empathetic vaccine discussions. Community leaders and organizations play a role in promoting vaccination. Further research on the relationship between confidence and health literacy is essential. Transparency, timely updates, and public-private partnerships are vital. Tailored interventions should address gender disparities and involve continuous monitoring. Fostering understanding, trust, and tailored strategies can enhance vaccine acceptance and coverage in France.

Acknowledgments

This work was supported by grants from the Agence Nationale de la Recherche (ANR-20-COVI-0035-01) and the Agence Nationale de la Recherche Scientifique—Maladie Infectieuses Emergentes (Comité ad-hoc de pilotage national des essais thérapeutiques et autres recherches sur la COVID-19 [CAPNET] project 0344). The funding sources had no role in the design of the study, analysis of the data, or writing of the paper. This material is the authors’ own original work, which has not been previously published elsewhere.

Data Availability

The data sets analyzed during this study are available in the Harvard Dataverse repository [ 39 ].

Conflicts of Interest

None declared.

Health literacy questionnaire (HLS19-Q12).

Health care system confidence questionnaire.

  • Vaccines and immunization. World Health Organization. URL: https://www.who.int/health-topics/vaccines-and-immunization [accessed 2022-05-10]
  • MacDonald NE, SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015;33(34):4161-4164. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Ten threats to global health in 2019. World Health Organization. URL: https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 [accessed 2022-05-12]
  • Shen S, Dubey V. Addressing vaccine hesitancy. Can Fam Physician. 2019;65(3):175-181.
  • Report of the SAGE Working Group on vaccine hesitancy. The Compass for SBC. URL: https://www.thecompassforsbc.org/sbcc-tools/report-sage-working-group-vaccine-hesitancy [accessed 2022-05-10]
  • State of vaccine confidence. European Commission. URL: https://ec.europa.eu/health/vaccination/state-vaccine-confidence_en [accessed 2022-05-10]
  • Géodes—santé publique France—indicateurs?: Martes, données et graphiques. URL: https://geodes.santepubliquefrance.fr/#c=indicator&view=map2 [accessed 2022-05-12]
  • Hudson A, Montelpare WJ. Predictors of vaccine hesitancy: implications for COVID-19 public health messaging. Int J Environ Res Public Health. 2021;18(15):8054. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Tokiya M, Hara M, Matsumoto A, Ashenagar MS, Nakano T, Hirota Y. Association of vaccine confidence and hesitancy in three phases of COVID-19 vaccine approval and introduction in Japan. Vaccines (Basel). 2022;10(3):423. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Larson HJ, Gakidou E, Murray CJ. The vaccine-hesitant moment. N Engl J Med. Jul 07, 2022;387(1):58-65. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Goldenberg MJ. Vaccine Hesitancy: Public Trust, Expertise, and the War on Science. Pittsburgh, PA. University of Pittsburgh Press; 2021.
  • Liu C, Wang D, Liu C, Jiang J, Wang X, Chen H, et al. What is the meaning of health literacy? A systematic review and qualitative synthesis. Fam Med Community Health. 2020;8:e000351. [ FREE Full text ]
  • Sørensen K, Van den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:80. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Biasio LR, Carducci A, Fara GM, Giammanco G, Lopalco PL. Health literacy, emotionality, scientific evidence: elements of an effective communication in public health. Hum Vaccin Immunother. 2018;14(6):1515-1516. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • La littératie en santé?: un concept critique pour la santé publique. SPF. URL: https:/​/www.​santepubliquefrance.fr/​notices/​la-litteratie-en-sante-un-concept-critique-pour-la-sante-publique [accessed 2022-05-12]
  • Hickey KT, Creber RMM, Reading M, Sciacca RR, Riga TC, Frulla AP, et al. Low health literacy: implications for managing cardiac patients in practice. Nurse Pract. 2018;43(8):49-55. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107. [ CrossRef ] [ Medline ]
  • Montagni I, Ouazzani-Touhami K, Mebarki A, Texier N, Schück S, Tzourio C, et al. CONFINS group. Acceptance of a COVID-19 vaccine is associated with ability to detect fake news and health literacy. J Public Health (Oxf). 2021;43(4):695-702. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Siena LM, Isonne C, Sciurti A, De Blasiis MR, Migliara G, Marzuillo C, et al. The association of health literacy with intention to vaccinate and vaccination status: a systematic review. Vaccines (Basel). 2022;10(11):1832. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Tian CY, Mo PKH, Dong D, Qiu H, Cheung AWL, Wong ELY. Associations between health literacy, trust, and COVID-19 vaccine hesitancy: the case of Hong Kong. Vaccines (Basel). Mar 01, 2023;11(3):562. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Pelikan JM, Link T, Straßmayr C, Waldherr K, Alfers T, Bøggild H, et al. Measuring comprehensive, general health literacy in the general adult population: the development and validation of the HLS-Q12 instrument in seventeen countries. Int J Environ Res Public Health. Oct 29, 2022;19(21):14129. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Bilendi and Respondi. URL: https://www.bilendi.fr/ [accessed 2024-04-10]
  • McKinley CJ, Olivier E, Ward JK. The influence of social media and institutional trust on vaccine hesitancy in france: examining direct and mediating processes. Vaccines (Basel). Aug 03, 2023;11(8):1319. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Ward JK, Gauna F, Deml MJ, MacKendrick N, Peretti-Watel P. Diversity of attitudes towards complementary and alternative medicine (CAM) and vaccines: a representative cross-sectional study in France. Soc Sci Med. 2023;328:115952. [ CrossRef ] [ Medline ]
  • Turhan Z, Dilcen HY, Dolu I. The mediating role of health literacy on the relationship between health care system distrust and vaccine hesitancy during COVID-19 pandemic. Curr Psychol. 2022;41(11):8147-8156. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • White RO, Osborn CY, Gebretsadik T, Kripalani S, Rothman RL. Health literacy, physician trust, and diabetes-related self-care activities in Hispanics with limited resources. J Health Care Poor Underserved. 2013;24(4):1756-1768. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Peretti-Watel P, Larson HJ, Ward JK, Schulz WS, Verger P. Vaccine hesitancy: clarifying a theoretical framework for an ambiguous notion. PLoS Curr. 2015;7:ecurrents.outbreaks.6844c80ff9f5b273f34c91f71b7fc289. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Tsai TI, Yu WR, Lee SYD. Is health literacy associated with greater medical care trust? Int J Qual Health Care. 2018;30(7):514-519. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Ward JK. Annexes électroniques de l'article "Journalists and Science. Boundary-making in the media coverage of the 2009 pandemic flu vaccine's safety in France". Sociologie. 2019. URL: https://journals.openedition.org/sociologie/6070?lang=en [accessed 2023-10-05]
  • Cafiero F, Guille-Escuret P, Ward JK. "I'm not an antivaxxer, but...": spurious and authentic diversity among vaccine critical activists. Soc Netw. 2021;65:63-70. [ CrossRef ]
  • Motta M. Republicans, not democrats, are more likely to endorse anti-vaccine misinformation. Am Polit Res. 2021;49(5):428-438. [ FREE Full text ] [ CrossRef ]
  • Pennycook G, Bago B, McPhetres J. Science beliefs, political ideology, and cognitive sophistication. J Exp Psychol Gen. 2023;152(1):80-97. [ CrossRef ] [ Medline ]
  • Schmid P, Rauber D, Betsch C, Lidolt G, Denker ML. Barriers of influenza vaccination intention and behavior - a systematic review of influenza vaccine hesitancy, 2005 - 2016. PLoS One. 2017;12(1):e0170550. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Galistiani GF, Matuz M, Matuszka N, Doró P, Schváb K, Engi Z, et al. Determinants of influenza vaccine uptake and willingness to be vaccinated by pharmacists among the active adult population in Hungary: a cross-sectional exploratory study. BMC Public Health. 2021;21(1):521. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Arriaga M, Francisco R, Nogueira P, Oliveira J, Silva C, Câmara G, et al. Health literacy in Portugal: results of the Health Literacy Population Survey Project 2019-2021. Int J Environ Res Public Health. 2022;19(7):4225. [ FREE Full text ] [ CrossRef ] [ Medline ]
  • Brown AL, Sperandio M, Turssi CP, Leite RMA, Berton VF, Succi RM, et al. Vaccine confidence and hesitancy in Brazil. Cad Saúde Pública. Sep 21, 2018;34(9). [ FREE Full text ] [ CrossRef ]
  • Household income and wealth: inequality in living standards and poverty between 2008 and 2018. Insee. URL: https://www.insee.fr/en/statistiques/5411354?sommaire=5411369 [accessed 2022-06-21]
  • Tailoring Immunization Programmes (TIP). URL: https://www.who.int/europe/publications/i/item/9789289054492 [accessed 2022-07-28]
  • Khoury G. Health literacy and healthcare system confidence as determinants of attitudes to vaccines: a representative cross-sectionnal study in France. Harvard Dataverse. 2024. [ CrossRef ]

Abbreviations

Edited by A Mavragani, T Sanchez; submitted 19.01.23; peer-reviewed by K Tassiopoulos, JJ Wu; comments to author 17.08.23; revised version received 05.10.23; accepted 25.01.24; published 07.05.24.

©Georges Khoury, Jeremy K Ward, Julien Mancini, Amandine Gagneux-Brunon, Liem Binh Luong Nguyen. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 07.05.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Public Health and Surveillance, is properly cited. The complete bibliographic information, a link to the original publication on https://publichealth.jmir.org, as well as this copyright and license information must be included.

COMMENTS

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