The COVID-19 pandemic has had a profound impact on every country throughout the world. According to the most updated report by the World Health Organization, there have been more than 163 million cases of COVID-19 and more than 3 million deaths; new cases and deaths attributed to SARS-CoV2 continue to the present [1].

The COVID-19 pandemic and accompanying public health containment measures have had a significant impact on patient’s needs, lifestyle practices, mental health issues, and health care seeking behaviors in many countries as well as patient’s financial resources [2–4]. Patients tend to delay going for regular check-up visits due to fears of becoming infected with SARS-CoV2 or because many health care facilities have either postponed their check-up appointments or non-urgent care to focus on COVID-19 treatment [3, 4]. Another potential negative impact of this pandemic may be decreased medication availability and patient adherence for the management of important chronic diseases and patients may self-manage or even stop taking their medications which may in turn lead to poor health outcomes [2–5].

Vietnam, a lower middle-income country with a population of nearly 100 million and limited resources, has successfully slowed this pandemic and its accompanying morbidity and mortality through various societal and public health measures [6–10]. These include the quarantining of possible cases of COVID-19, widespread testing, case detection and isolation, contact tracing, social distancing, and lockdowns. Strict and mandatory social distancing has been applied nationwide from early March through the end of April, 2020, and mandatory lockdowns have been put in place in several affected areas. To date (May 16, 2021), a total of 4,118 cases of COVID-19 have been diagnosed in Vietnam, with 36 deaths attributed to this viral infection [11]. The pandemic has impacted every aspect of society in Vietnam, including clinical and public health research activities. Public health and clinical initiatives to protect the general public and treat persons affected by the virus have been prioritized in an attempt to reduce the impact of the pandemic. Inasmuch, research activities which are not directly related to COVID-19 have been postponed, and investigators and their study teams have faced numerous challenges in carrying out their intended activities.

Several recently published studies have examined the impact of COVID-19 and public health containment measures in the Vietnamese population [12–16]. To our knowledge, no study has examined the impact of COVID-19 on patient’s needs, health care seeking behaviors, and research participation in an ongoing clinical trial. The objectives of this report are to explore the impact of the COVID-19 pandemic on research activities in Vietnam using data from a mixed quantitative and qualitative study conducted among patients and health care workers currently participating in an ongoing clinical trial which is designed to improve hypertension control in Vietnam.

The results of the brief patient questionnaire survey and small group discussion showed that fears and concerns about COVID-19 had impacted patients in the ongoing clinical trial of hypertension control as well as health care workers with regards to study adherence and implementation; these findings are consistent with the results of several recent publications [22–24]. For example, a systematic review of 6 published papers between January and September 2020 which examined the impact of the COVID-19 pandemic on ongoing clinical trials showed that the pandemic had significantly impacted the implementation and conduct of clinical trials worldwide [24].

Several studies have been recently published examining the impact of COVID-19 and public health control measures on the general Vietnamese population. These observational studies showed that the pandemic has had a significant impact on the overall well-being and mental health status of this population [12–16].

In the present study, patients were worried about becoming infected by the SARS-CoV2, and about the timely receipt of medical care and treatments for their chronic conditions, which are consistent with the findings of other recent studies [2–5]. Furthermore, patients who are participating in a health research study face additional challenges of adhering to study visits, medications, and study interventions and procedures as a consequence of quarantine and social distancing policies, which are in line with the findings of prior studies [22–24].

In the present study, patients in the comparison group found it more difficult to adhere to the trial-based interventions than those in the intervention group. These differences may be explained by the fact that the intervention group received extended services of community health workers while those enrolled in the comparison group did not. In addition, more patients in the comparison group expressed that they wanted to be contacted either by phone or by community health worker’s visits to their homes when facing difficulties for intervention adherence. This finding highlights the importance of the numerous important activities regularly performed by community health workers in rural settings of Vietnam.

Unexpected and rapidly evolving health crises, such as the COVID-19 pandemic, where various public health socially isolating control measures have been implemented, will significantly impact health research activities in many ways [22–24]. Inasmuch, new approaches need to be considered to maintain and optimize various research activities.

One such approach is to expand the use of mhealth or telemedicine in clinical and public health research [23, 24]. The results of the present survey showed that, even in older study participants, approximately one-half felt comfortable to use a mobile phone in research related activities. However, fewer patients in the intervention group stated that they would be willing to participate in a research project that would use a mobile phone for delivery of a storytelling intervention and for interviews compared with those in the comparison group. Patients in the intervention group may feel satisfied with home visits by community health workers and enjoyed the storytelling DVDs which they can watch with other family members and neighbors. This finding suggests that multiple approaches for intervention delivery and data collection are needed to overcome difficulties during future health crises and enhance the implementation of future research studies.

With proper training and careful planning and preparation for both participants and health care workers, mhealth can be successfully applied in countries such as Vietnam. A 2018 report showed that 72% of the Vietnamese population had access to a smartphone device, and two-thirds used their smartphones on a daily basis to watch videos [25]. Zalo, a Vietnamese app, is the most popular messaging app in Vietnam; 80% of smartphone users in Vietnam have Zalo installed on their phones [26]. Therefore, future health research studies should consider using this app or other similar apps for intervention delivery and data collection activities.

Due, in part, to the pandemic, health care workers have an increased workload to follow-up patients while ensuring that government policies to control the ongoing pandemic are appropriately implemented. Research staff faced challenges of adhering to the trial protocol in a timely manner while ensuring patient safety. In the ongoing trial, we worked closely with local health leaders, physicians and nurses at community health centers, and community health workers to discuss how best to deal with the pandemic and modify the action plans accordingly. To the credit of the research study staff and participating health care providers, and the willingness of patients to be enrolled in the trial, we have been able to keep patient recruitment to the ongoing trial of hypertension control on schedule. More research is needed, however, to understand the impact of the COVID-19 pandemic on the socio-economic, physical, and mental health status of the general population as well as patients with various chronic conditions.

The strengths of the present study include the timely investigation of the impact of COVID-19 on patients and health workers who are currently participating in a health research study in Vietnam. However, the questionnaire survey has several limitations. First, it was conducted among a small number of study participants, who were eligible for follow up visits. Second, a limited number of questions related to COVID-19 were included in the follow-up data collection forms to avoid further burdening patients and study staff in their follow-up visits. Third, there were no questions related to patient’s willingness to take available vaccines for the SARS-CoV-2 virus, which is an important question given the current availability of several vaccines and unfounded concerns with vaccination. Future studies should explore this aspect to prepare for large-scale vaccination programs in Vietnam when the vaccine is available for use. Vietnam has a strong public health system for the implementation of immunization programs for children but not for adults. Therefore, obtaining insights about the general population’s willingness and concerns to be vaccinated and potential obstacles for the national roll-out of a SARS-CoV-2 vaccination program are key for successfully controlling the current and future epidemics.

The COVID-19 pandemic is an unprecedented worldwide crisis which has had adverse effects on many aspects of daily life, including research studies. Health care workers were overloaded by both their clinical and research duties. Patients faced difficulties in keeping their current health status and adhering to study interventions. Multiple approaches for intervention delivery and data collection are needed to overcome difficulties during future health crises and enhance the implementation of future research studies.