Beyond Infection Control: Multidimensional Unmet Needs and Health-System Gaps During the COVID-19 Pandemic in India—A Convergent Mixed-Method Study

The COVID-19 pandemic created widespread disruptions extending beyond infection-related health concerns, affecting economic stability, nutrition, mental health, education, social well-being, and access to essential healthcare. This study examined multidimensional unmet needs and health-system gaps experienced by adults in India during the COVID-19 pandemic, assessed associations between selected sociodemographic characteristics and major unmet needs, and integrated quantitative and qualitative findings to contextualize pandemic-related vulnerabilities and health-system disruptions. A convergent mixed-method design was employed. Quantitative data were collected through a web-based cross-sectional survey between December 2021 and January 2022 using convenience and snowball sampling, with 958 adults completing the survey. A structured questionnaire assessed unmet needs across eight domains: economic, nutritional, social, spiritual, mental health, preventive, childcare, and healthcare. Descriptive statistics and Pearson’s chi-square tests examined unmet needs and associations with psychological stress, job or salary disruption, children’s learning difficulties, and difficulty accessing routine healthcare. Twenty information-rich open-ended responses were purposively selected for inductive thematic analysis, and findings were integrated through side-by-side comparison. Employment or salary disruption (79.1%) and difficulty meeting household expenses (71.8%) were the most frequently reported concerns. Nutritional difficulties (63.4%), anxiety (40.2%), psychological stress (39.9%), and children’s learning difficulties related to online education (46.1%) were also prominent. Household income was significantly associated with psychological stress, job or salary disruption, children’s learning difficulties, and difficulty accessing routine healthcare (all p ≤ 0.001). Place of residence was associated with psychological stress (p = 0.011) and children’s learning difficulties (p < 0.001). Qualitative findings generated five themes: compromised childcare and educational support; economic instability and loss of livelihood; disrupted healthcare access; psychological distress and work–life imbalance; and unmet preventive and informational needs. Overall, the findings demonstrate that pandemic-related vulnerabilities were multidimensional and interconnected. Future pandemic preparedness should incorporate continuity of essential healthcare, social protection, mental health support, reliable risk communication, educational and digital inclusion, and coordinated community-based services. Given the online non-probability sampling approach and the predominance of participants from South India, the findings should not be interpreted as nationally representative estimates of unmet needs across India.