1. IntroductionThe COVID-19 pandemic has resulted in the drastic loss of human life worldwide, and has presented unprecedented challenges for public health, food systems, and the world of work, including the education system [1]. COVID-19 has threatened student lifestyles. This pandemic has left people fearing for their safety and well-being, and campuses have been no exception. With classes cancelled, students struggling to access food and water, and dormitories overflowing, the student lifestyle has considerably changed. The spread of COVID-19 has had many impacts on people with mental health conditions and on mental health care globally [2]. Within this context, the main concerns of and changes faced by students are mental health, sleep, stress, learning environment, technology use, food, study habits, and social life. Students need to be supported in coping with the impacts of COVID-19; universities need to provide support and resources that are tailored to the unique needs of students. The stress and self-efficacy experienced by students should be considered by healthcare providers, families, and educators when devising interventions to encourage healthy physical and psychological behaviours in university students [3].The new lifestyle and new normal due to COVID-19 have impacted on the university and student lifestyle in Asia [4]. The COVID-19 pandemic has led to several lifestyle changes, both within and outside the university environment. Amongst students, many have found that their social lives have shrunk, as forms of communication such as messaging and social media have become less effective. In addition, those who have been most affected by the virus are students, who are least likely to maintain healthy lifestyle habits, which leads to increased levels of anxiety and stress, which affects academic performance. Universities and colleges were already struggling to keep up with the ever-changing demands of the modern world; they are now also affected by changes due to the COVID-19 pandemic [5]. One such challenge is to balance the need for students to stay healthy and safe with their need for freedom and flexibility. Whereas some universities have implemented rigid policies that restrict students’ movements, others have tried to find a balance that allows for both safety and freedom [6].Way of life involves people’s daily activities that have become routine or habit [7]. Neuroscientists think that lifestyle is caused by a nervous system mechanism that adjusts the circadian rhythms of the body, also known as the biological clock (such as the sleep–wake cycle, hormonal cycles, etc.), to environmental conditions (such as day, night, month, seasons, and year) [8]. Circadian rhythms and sleep disruption contribute to cell dysfunction if the body is unable to generate energy to repair and create new cells to replace dead cells [9]. This disruption leads to numerous chronic diseases [10]. To address these lifestyle issues, occupational therapy focuses on meaningful and purposeful human activities that are essential to health, comprising the core aim of the profession: helping people of all ages, including people with disabilities and limitations, perform everyday tasks or occupations [11,12].Kielhofner [13] described the model of human occupation (MOHO) in terms of three levels of individual functional states in everyday life or lifestyle: occupational identity (recognizing who you are and what you want), occupational competence (participating in a range of occupations to meet the standard expectations of social norms and to sustain a satisfying pattern of occupational behaviour), and occupational adaptations (involving one’s adaptive response to meet an occupational challenge [14]. Kielhofner’s MOHO describes the three components of lifestyle—volition, habituation, performance capacity—which involve environment and lifestyle activities [13]. Volition refers to the motivation for occupation and the power to make one’s own decisions with interest, personal causation, and values. Habituation is the process of organizing occupations and routines. Performance capacity refers to the physical and mental abilities that underlie skilled engagement in occupations (such as musculoskeletal, neurological, and cardiopulmonary systems, and cognitive or mental processes, such as memory, planning, etc.) [13]. Kielhofner’s findings complemented those of Smith et al. [15] in terms of the aforementioned three components of lifestyles, which were found to be associated with life satisfaction. Time spent at work and leisure more positively correlated with the levels of life satisfaction than routines.Velde and Fidler [16] designed the lifestyle performance model as a model of occupational therapy practices that emphasizes the power of occupation. They defined lifestyle as a component of a person’s total activity repertoire within the context relevant to the needs of the individual and the sociocultural norms of the society in which the person lives. They stated that each person has the ability to consistently develop their own lifestyle performance to attain a good-quality life through four domains of activities: self-care and self-maintenance, intrinsic gratification, social contribution, and reciprocal interpersonal relatedness. In the promotion of wellness, prevention and occupational therapy services are based on the four domains of activities of the lifestyle performance model, which are essentially centred around the individual’s daily lifestyle activities.Presently, Thailand has only three occupational therapy school providers. The first occupational therapy educational program was founded in 1980 at Chiang Mai University in northern Thailand [17]; the second school was established in 2008 at Mahidol University in Bangkok, the capital city of Thailand [18]. Now, the third school has been established by the Srinakharinwirot University and the Department of Medical Services, Ministry of Public Health, which enrolled the first cohort of occupational therapy students in 2022 [19]. Occupational therapists are a profession that works with individuals who are having difficulty in performing daily activities and meaningful occupations. Occupational therapists help people with various conditions by conducting assessments and designing individualized treatments [12]. Occupational therapy students require a lot of knowledge about human movement and body functions, psychosocial functions, development from birth until adulthood, health as well as theories, frames of reference, models related to health and well-being. As the progress through this program, they gain invaluable clinical experience in an outpatient setting as well as internships at hospitals, rehabilitation centres and communities throughout Thailand. The outbreak of the COVID-19 pandemic has created many challenges for occupational therapy students as they learned their studies with working from home and caring for their families. This has led to increased levels of stress and anxiety among the students. Moreover, the outbreak of COVID-19 has led to a change in their lifestyle and mental health, which may have an impact on their career and future. Because of this, it is important for educational executives and occupational therapy educators to be aware of the potential impact of the pandemic on the mental health and lifestyle of occupational therapy students so that they can provide support and resources to help them cope with the challenges they may face.However, relatively little research has focused on new lifestyles. Humans are occupational beings; thus, participating in everyday activities contributes to good health [20]. However, many occupational therapy students are struggling to find the right path after their graduation amid the COVID-19 pandemic. The outbreak of the COVID-19 pandemic has led to an unprecedented global health crisis, with significant implications for mental health. The mental health of occupational therapy students has been negatively affected by the outbreak of the pandemic. In addition to the classroom and clinic experiences, occupational therapy students in Thailand were also required to complete a clinical practice. The purpose of the clinical fieldwork is to integrate the students’ current knowledge with real-world experiences. It may lead to significant changes in the way of their thought related to clinical skills and work performance. Therefore, the authors conducted this pilot study with a study group of undergraduate students enrolled in an occupational therapy program at Chiang Mai University to explore the impact of COVID-19 in occupational therapy students. Purpose of the Study

There are very few studies regarding the new normal lifestyle of Thai students in occupational therapy programs during the COVID-19 pandemic. Occupational therapy students will become occupational therapists who play a vital role in promoting health and preventing disease and disability. Hence, it is important to know how occupational therapy students adapted themselves to a new lifestyle during the COVID-19 pandemic. The specific objectives of this study are:

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To investigate the impact of the COVID-19 pandemic on the mental health and lifestyle of occupational therapy students’ experiences.

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To explore the activities and lifestyle of occupational therapy students’ perspectives during the COVID-19 pandemic.

2. Materials and Methods

This study addressed the exploration of experience and perspective of occupational therapy students in terms of their mental health and new normal lifestyle activities during the impact of COVID-19. This research received ethical approval from the Associated Medical Sciences Research Ethical Committees, Chiang Mai University, code AMSEC-63EX-065.

This study used a mixed method design to collect both survey data and interview responses from occupational therapy students. Mixed methods research combines qualitative and quantitative approaches to help answer the research question [21]. Participants were recruited participants between November 2020 and April 2021 during the COVID-19 pandemic. Based on location and ethical approval, this study used both convenience and purposive sampling by selecting participants attending the university [22].A convergent mixed methods design was used [23], a type of design in which qualitative and quantitative data are collected in parallel, analysed separately, and then merged. In the qualitative inquiry, semi-structured qualitative interviews were conducted with 12 students (5 males and 7 females). In-depth interview data discovered the central phenomenon for occupational therapy students in their experiences in the response to individual adaptation, mental health, and new lifestyle activities. The interview data were analysed by content analysis [24]. In contrast of the quantitative study, questionnaire surveys were used to explore everyday activities of occupational therapy students (n = 99), visual activities and auditory activities and meaningful activities during the COVID-19 pandemic. The survey data were analysed using descriptive statistics and frequencies. Based on the research design, the structured results of this study integrated textual (qualitative) and numerical (quantitative) data (Figure 1) to present the study findings as a combination of information with relationship and coherence. 2.1. Interview ProcedureAccording to Barriball and While [25], as a method of exploring perception and opinions, a semi-structured interview is well suited to elicit information and clarification from respondents about complex issues. A question may be sensitive and enable a clarification and more information to be sought. This study was designed and refined the interview guidelines by an iterative process involving mock individual in-depth interviews prior to its use. The semi-structured interviews comprised the questions provided in Table 1.As the wordings and sequence of all the questions in a standardized interview schedule were the same for each respondent, the authors ensured that any differences in the answers were due to differences between the respondents rather than in the questions asked [26]. The interview protocol was validated with an expert review and pilot test to ensure the focus of the interview [27]. The data collection process was continued until data saturation, when it had enough information to replicate the study [28], when authors were no longer able to obtain additional new information, and when further coding was no longer feasible [29]. 2.2. Interview Participants and Recruitment

Participants were recruited based on the following criteria: (1) occupational therapy student; (2) willing to participate in an interview. The individual participants were excluded from the survey to avoid data duplication. The recruitment advertising was presented to student accommodations and the learning buildings over a one-month period. After participants were contacted by the research team, they were selected based on the inclusion criteria.

2.3. Survey ProcedureA variety of sensory processing pattern assessments are currently used to implement healthcare services. The Thai Sensory Patterns Assessment (TSPA) tool was developed in Thailand by Tiam Srikhamjak and colleagues [30,31]. Dunn’s sensory profile can be adapted to Thai’s sensory patterns assessment (TSPA) tool for adolescents and adults in two parts: sensory preferences and sensory arousal. A sensory preference is defined as the behaviour you prefer to express in relation to a particular sensory stimulus in your daily life. An instance of sensory arousal occurs when a person responds impulsively to a particular sensory stimulus. In this previous study, a multistage sampling method was used to select the sample group. A total of 400 participants aged over 15 years in Chiang Mai province were recruited for examining internal consistency, and 40 participants were recruited for testing test–retest reliability. Using the TSPA tool is easy, and it can be used to link behaviour responses to sensory stimuli in a variety of ways. The previous study showed that the TSPA tool for adolescents and adults provided a feasible tool for identifying sensory preferences to match health promotion modalities appropriately [32].The authors developed a questionnaire survey using TSPA for adolescents and adults, which consists of two modules: one for sensory preferences with 35 items and the second for sensory arousals with 25 items. Each module is divided into six categories according to the type of sensory modalities: sight, sound, smell and taste, touch, proprioceptive, and vestibular systems [32]. The content validity examination of the index of item–objective congruence (IOC) of the modules I and II ranged from 0.60 to 1.00. Authors assessed the internal consistency reliability of the questions, receiving an α coefficient of 0.89 for module I and 0.62 for module II. The test–retest reliability with intraclass correlation coefficient (ICC) method was 0.91 in module I and 0.92 in module II. In conclusion, it was found that the TSPA was both valid and reliable at an acceptable level.The questionnaire survey included two parts of questions: (I) personal information; (II) taking the self-report assessment. The participants were instructed to read each question and then select their answer by marking a cross (X) in the box corresponding to the frequency of the six sensory neurological response behaviours that are normal in daily life with the following criteria: Never: never feel like or behave like this, where the behaviour is shown only 5% of the time; Seldom: rarely respond to the stimuli, where the behaviour is shown only 25% of the time; Occasionally: this behaviour often happens at least once per week, where the behaviour is shown 50% of the time; Frequently: this behaviour happens at least once per day, where the behaviour is shown 75% of the time; Always: feel like this behaviour happens at least several times per day. This sensory pattern reflected visual, auditory, smell/taste, and movement activities that are involved in activities of daily living during the COVID-19 pandemic. The domains and questions were used to explore the sensory patterns of occupational therapy students, as shown in Table 2. 2.4. Survey Participants and Recruitment

The inclusion criteria for the participants were undergraduate students who were enrolled in the occupational therapy program for the second semester of the academic year 2020, which included first-, second-, third-, and fourth-year students. The recruitment for study participation was sent through a student leader of each class year. Authors used sampling to identify and select information-rich cases related to the subject of interest in this study.

2.5. Data Collection

For the qualitative inquiry, the data were collected in December 2020–January 2021. Authors contacted the occupational therapy students based on the inclusion criteria to arrange the most convenient time and used Zoom to conduct the individual interviews. The interviews were utilized by a semi-structured interview guideline. Each participant was required to read and sign a written consent form before the interview. The interviews were audio-recorded and then transcribed verbatim. The in-depth interviews lasted approximately 45–60 min. Authors clearly documented all research processes, and the team peer reviewed the transcripts. This study used pseudonyms to protect the identity of the participants.

For the quantitative approach, there were 99 occupational therapy students who were willing to answer the questionnaire with the sensory pattern assessment form, demographic questionnaires, consent forms, cover letters, and stamped return envelopes in November and December 2020. All participants read and signed written consent forms before answering the questions.

2.6. Data AnalysisFor the qualitative analysis, seven female and five male occupational therapy students (mean age = 20 years) participated in the individual interview. The participants were between 18 and 23 years of age across different years of study, as first- to fourth-year occupational therapy students, and all signed consent forms before entering the study. Pseudonyms were used to protect the identity of the participants. Characteristics of the participants are presented in Table 3.Individual interview responses were analysed by content analysis [24]. This analytical process utilized five steps: (1) the interviews were listened to and thereafter read through several times to obtain a sense of the whole; (2) the transcribed text was divided into units of meaning, which were condensed and labelled with codes; (3) the codes were compared, looking for similarities and differences, and then sorted into subcategories and two main categories; (4) verified that the coding was congruent with the units of meaning; (5) the latent content was formulated into an overarching theme. Moreover, the interviews were analysed and interpreted data related to the living environment and the lifestyle in accordance with Kielhofner’s human occupation model [13] and the Velde and Fidler’s lifestyle performance model [16]. The triangulation methods validated the data by member checking. Authors organized, coded, and categorized the data by themes. Detailed summaries of each theme are described in the Results section.For the quantitative analysis, descriptive statistics were used to analyse the data that were returned by the end of December 2020, which included frequencies and percentages. A questionnaire survey was also completed concerning occupational therapy students’ perspectives; these participants provided consent to participate in this study. The demographic information of the participants included students in the age range between 18 and 25 years of age (mean age = 20.75). The respondents were in an occupational therapy program (n = 99) that included males (26.3%, n = 26), and females (73.7%, n = 73). This was presented by first-year (30.3%, n = 30), second-year (23.2 %, n = 23), third-year (25.3%, n = 25), and fourth-year (21.2%, n = 21) occupational therapy students (Table 4.). 2.7. Rigor and TrustworthinessThe potential translation-related problems were examined that might have interfered with the trustworthiness of the results. The transcripts were analysed word-for-word in the native language (Thai) and then were translated into English [33]. These transcripts were checked by two academics fluent in Thai and English and then back-translated from English into Thai. While translating and analysing the data, they considered the challenges of translating. To maintain semantic equivalence with realistic and textual meanings, authors considered linguistic differences. For example, an expression in one language may not be present in another [34]. The trustworthiness created an audit trail to provide support for interpretations and analyses [35]. Adequate translation contributes to a study’s trustworthiness because it ensures accurate data, inclusivity, consistency, and transparency during the analytical process [36]. To increase data transferability, authors documented the process and peer-reviewed the transcripts. Three independent reviewers spent a large amount of time on data translation, demonstrating our rigor in this study. Moreover, we invited participants to validate the findings by confirming or suggesting variant meanings that could be incorporated into the final version. 4. DiscussionIn this study, the time-based daily life patterns of the activities of the students were consistent with Kielhofner’s model of human occupation [13], in which students are motivated and patterned, and performed meaningful activities, particularly educational activities. Considering the lifestyle performance model of Velde and Fidler [16], the patterns of students’ daily life activities did not indicate a good quality of life as determined by the four domains of activities: self-care and self-maintenance, intrinsic gratification, social contribution, and reciprocal interpersonal relatedness. For example, most students woke up late on Monday through Friday, rushed to attend online classes, and did not take a shower or eat breakfast. During lunch time, they ordered food delivery using applications. Despite having spare time on Saturday and Sunday, students went to bed late and woke up late in the afternoon. They did not eat breakfast or perform activities for pleasure.

Students spent time on leisure activities Monday through Friday. They alternated spending time on leisure activities with educational activities on the weekend, afternoon and throughout the evening. Before bedtime, students likely spent time on passive activities (such as watching YouTube, movies, cartoons, or TV series; playing games on the computer; etc.) that required the use of visual sense, which they had been using throughout the week, instead of performing physical activities (such as sports and exercise). The responses showed that students (43.3% Monday–Friday, 40% Saturday–Sunday) in first year performed physical activities such as exercise. The rest of the students in other years of the program spent less time exercising because of the increased academic workload in the occupational therapy program.

First-year students spent more time participating in leisure and exercise activities than students in the other years of study. It was possible that this happened with first-year occupational therapy students in Thailand due to the COVID-19 pandemic. As the students graduated from high school and became university students, the Thai government promoted physical distancing and university-regulated online learning for them. As a result, they stayed home and could perform activities that they wanted to. Fourth-year occupational therapy students spent less time on leisure and exercise. The possibility of this occurring with this group was due to the fact that they were final-year occupational therapy students who were concerned about practical work and had to do a lot of homework. They may have also been worried about their future jobs. According to a study in England, nursing students who wish to undertake extended placements can do so from their homes if they cannot or do not wish to stay in university accommodations. In this period of rapid change, health services, government agencies, and educational providers will each have a different view of what these options might offer students in terms of benefits and risks [38]. Furthermore, nursing students in their final year were employed to provide nursing care during COVID-19. There were many concerns unresolved in their immediate futures. COVID-19 led to financial problems and job insecurity among university students in France [39]. It was found that the students most at risk were those who believed that the lockdown would negatively affect their employment prospects in the future [40].In terms of students’ patterns of spending time on activities, we have concerns about some neuroscientific factors. The human body releases the hormones necessary for self-repair in response to changes in environmental conditions between day and night and having a lifestyle that is inconsistent with nature [41,42]. Most students had late sleep–wake patterns, which posed a higher risk of biological clock deviation, which can impact overall health status. Therefore, educational institutions should consider implementing proactive strategies to ensure preservation of mental health. For example, students on some online courses may feel isolated. The use of online working groups may benefit from initiatives to increase social interaction and share ideas, including the positive feedback by educators.During COVID-19, students reported that they spent time on social media and chatting with friends. They had no concentration for online learning and did not understand the subject content. These negative impacts indicate the existence of a neuro-scientific phenomenon called habituation. Habituation is caused by a cluster of neurons that form the reticular activating system, which works in conjunction with the limbic and hypothalamus systems to modify the structure and function of the brain’s flexibility (neuroplasticity) by decreasing the response to repetitive stimuli as well as the connection between neurons or synapses [43,44]. As a result, alertness and focus on learning are reduced.Two approaches can be applied to increase the response to stimuli, called sensitization, which can increase alertness and focus on learning [45]. The first approach is by providing the subjects a seemingly harmful stimulus or threats that lead to the release of stress-causing chemicals, such as teacher reprimands or various forms of punishment. This approach results in the short-term restructuring and functioning of the habit. The second approach is based on the flexibility of the brain as well but is more sustainable: experience-dependent plasticity. Successful experience leads to the release of rewarding chemicals, causing enthusiasm to repeat the same activity over and over until it becomes a habit [43]. Determining which approach to choose is an important question for educators when designing a pedagogy that promotes student engagement in online learning as well as increases student alertness and focus on learning.In terms of the impact on social life, a critical review of Aristotle’s view on sociality [46] stated that humans are social animals: they flourish when in the company of others (“humans are social animals”, n.d.). They cannot exist without others. Psychologists and sociologists agree that one’s social life is one of the most important influences on mental and physical health. As a metaphor, human society is characterized as a spider web in which individuals interact with each other over the course of their lives. Such networks are an important source of training for various habits and skills. They are also sources of friends who have similar ideas and ideals with whom to converse, and exchange of information produces a sense of security, love, and being loved. However, measures for social distancing that keep people away from each other to prevent the spread of coronavirus cut off social networking and decrease social space.Moreover, surveys were conducted before and during the COVID-19 pandemic in Iceland to determine the level of depression, mental well-being, and substance use among adolescents. Symptom Checklist-90, Short Warwick Edinburgh Mental Well-being Scale, and frequency of cigarette smoking, e-cigarette use, and alcohol consumption were used in this study. As a result of COVID-19, adolescent mental health is significantly impaired. However, it is possible that the decline in substance use observed during the pandemic might be an unintended benefit of isolation. This might serve as a protective factor against future substance abuse disorders. A population-level prevention effort is necessary, especially for girls [47]. According to the study in Turkey, there was a study about the social support and psychological well-being of adolescents during the COVID-19 pandemic. There was a positive correlation between the scores for social support and psychological well-being. The study found that the levels of social support perceived by the adolescents were decent, even during the outbreak of COVID-19. The study showed that social support among adolescents increased, and their psychological well-being could be improved positively [48].Consequently, the data of this study were consistent with the results reported by Xiong et al. [2] regarding the impacts of COVID-19 on the sample population groups in eight countries, including China, Spain, Iran, the United States of America, Turkey, Nepal, and Denmark. The authors concluded that the COVID-19 pandemic had posed an unprecedented threat to students’ mental health, particularly with anxiety, depression, as well as emotional and general stress. The most high-risk population was found to be female with student status, younger than 40 years of age, with chronic mental illness and exposure to social media and COVID-19 news. 6. Conclusions

In summary, the COVID-19 pandemic has had both positive and negative effects on occupational therapy students’ lifestyles. Most students learned how to better protect and take care of themselves. In adaptive responses, students adapted themselves to engage in daily activities. They usually performed activities of daily living, rest, and sleep on a daily basis. However, they spent less time on exercise, and leisure activities were various depending on the year of the students. In multidimensional challenges, students faced economic impact, online activities, and impact on lifestyle and social life. It negatively affected students and, consequently, their emotional state and mental health problems. The COVID-19 pandemic led to a new normal for students involving more online learning activities, isolation from society, and financial crises. Their lifestyle choices also changed as a result of the pandemic. Students have been forced to confront many challenges that have taken a toll on their mental health. This has led to the negative effect that students faced with stress, anxiety, loneliness, frustration, boredom, and exhaustion. To support students with mental health challenges, university executives and educators should integrate agencies to strengthen students’ relationships and promote social–emotional learning and adaptation. They may use the findings of this study to prevent negative impacts on mental health and encourage academic achievement in the future, as well as general well-being, efficacy, and empowerment of students in the new normal post-COVID-19 pandemic era.