Introduction

Background

Owing to the long-term risk of Coronavirus disease 2019 (COVID-19) related infections, in late November 2019, reduced movement among people led to decreased economic consumption. This slowdown affected the economy, causing significant economic damage to small business owners in the restaurant industry, subsequently triggering a major economic recession [1,2]. Under the Korean Labor Standards Act, businesses with fewer than five employees are exempt from the legal standards that typically apply to businesses with five or more employees [3].

Small independent restaurant owners encountered various challenges during COVID-19, including loss of social connections, feelings of powerlessness, job insecurity, financial instability, and diminished hope for the future [4]. By 2021, industry revenues had dropped by over 30% compared to pre-pandemic levels in 2019 [5]. Small independent restaurant owners, many without specialized expertise or unique concepts, faced significant challenges such as low income, uncertain futures, and declining well-being [6]. Their social networks were also fragile and unstable [7]. Additionally, their business environment had significantly worsened compared to before the pandemic. Small independent restaurant owners operating in a highly sensitive to economic fluctuations were heavily impacted by COVID-19-related social distancing measures [8]. Nevertheless, they were responsible for rent and labor costs and felt that government aid, including stabilization funds and subsidies, was inadequate to improve business conditions at the onset of the COVID-19 pandemic [9].

A previous study indicates that food service owners experienced significant emotional stress as they struggled to adapt to pandemic-related changes, with many expressing anxieties about the future. The stressors caused by COVID-19 led to emotional exhaustion, decreased job satisfaction, lower self-esteem, and increased depression. Additionally, financial deficits and long working hours made it difficult for these owners to sustain their businesses, heightening their vulnerability to mental health issues [10].

A crisis is a psychological process where an individual faces an event that overwhelms their ability to cope, typically occurring in unpredictable situations [11]. Crises entail events that are difficult to manage or resolve using available coping resources, owing to unpredictable incidents or outcomes [12]. Crises often result in negative outcomes, such as financial losses and deteriorating physical or mental health, which can threaten overall well-being. The challenges from the COVID-19 pandemic, compounded by intense competition and prolonged economic downturns, have heightened psychological distress and hindered their ability to cope with crises [13]. Therefore, small independent restaurant owners experience emotional exhaustion coupled with negative feelings and distressing experiences [14,15]. This situation may exacerbate mental health issues, including higher suicide rates, depression, social isolation, and increased stress [16]. However, these challenging situations can also serve as critical turning points, offering opportunities for personal development [13]. By using coping mechanisms, individuals can process negative emotions and painful events, integrating them into their lives in a way that promotes balance and resilience [13,17]. A crisis presents both risks and opportunities for ego integration, where effective coping can lead to personal growth and transformation [17]. For small independent restaurant owners, work is not only a means of economic sustenance but also holds significant psychosocial value [7]. As the food service industry is particularly sensitive to economic fluctuations and is a key part of the livelihood economy, understanding the crisis experiences of small business owners in this sector is essential [6,17].

Therefore, a comprehensive understanding of their crisis experiences and adaptations to these challenges is required. To date, most domestic research regarding the crisis in South Korea has concentrated on small business sectors, limiting our understanding of the unique experiences and challenges beleaguering small independent restaurant owners [18-22]. Furthermore, there is a paucity of research on the COVID-19-related experiences of small independent restaurant owners [23-27]. Thus, exploring effective methods for assessing their psychological health, emotional well-being, and resilience in response to enforced restrictions is crucial.

Despite significant sociopsychological distress, research on the COVID-19 crisis and small food service business owners in South Korea has mainly focused on quantitative data, with few qualitative studies exploring the adaptation process [28]. Quantitative research often centers on policy, offering a limited perspective on the situation [29]. Therefore, there is a need for nursing strategies that support the psychological health, emotional well-being, and resilience of those affected by restrictions. Qualitative research, particularly grounded theory, can provide insights into the psychological states, adaptation strategies, and experiences of small restaurant owners, aiding in the development of effective interventions for recovery during trauma [30]. Through semi-structured interviews, we explored the lived experiences of small independent restaurant owners during the COVID-19 pandemic, aiming to understand the psychosocial challenges they faced. Adopting a nursing approach that addresses these challenges is essential for providing effective strategies to support them during the crisis. Using a grounded theory approach, we examined the experiences of small restaurant owners within South Korea’s sociocultural context to provide a deeper understanding and lay the foundation for targeted nursing interventions.

Aim and Objectives

This study employs a grounded theory approach to examine the lived experiences of small independent restaurant owners in South Korea, with a focus on the sociocultural context during the COVID-19 pandemic.

Methods

Study Design

We used Corbin and Strauss’s [30] grounded theory approach to explore the lived experiences of small independent restaurant owners affected by the COVID-19 pandemic.

Participants

Study participants were small independent restaurant owners in South Korea who shared their personal experiences during the COVID-19 pandemic. They were recruited from individuals registered at G Mental Health Welfare Center. Recruitment was conducted by posting a notice on the center's website, targeting those who wished to participate between September 30, 2022, and January 20, 2023. The G Mental Health Welfare Center, established in 2000 and collaborating with the Research Institute of Nursing Science at K University since 2004, has served as a specialized mental health institution. The study’s purpose, methods, and procedures were explained to potential participants over the phone, and their consent was obtained. Psychological support materials and informed consent forms were then provided, with written consent obtained from participants. The first participant was selected from the center based on purposive sampling, with subsequent participants referred through word-of-mouth from previously recruited individuals. A total of 15 participants were recruited using purposive and snowball sampling.

We included participants who could reflect on their experience, sign the consent form, and were able to participate in the counseling process without difficulty. We administered a preliminary psychological assessment through the G Mental Health Welfare Center to ensure that participants fell within the normal range for COVID-19-ensuing psychiatric stress. Stress levels were measured using the Stress Response Inventory (SRI), developed by Koh et al. (2000) in South Korea [31]. The SRI includes 39 items across seven subscales: Tension (6 items), Aggression (4), Somatization (3), Anger (6), Depression (8), Fatigue (5), and Frustration (7), rated on a 5-point Likert scale from 0 (not at all) to 4 (very much so). Higher scores indicate greater stress, with a total range from 0 to 156. Koh et al. (2000) reported a Cronbach’s α of .97, with an optimal cutoff score of 21. Exclusion criteria included individuals who fell outside the normal range on the SRI [31] and those with cognitive impairment or post-traumatic stress disorder [32].

Data Collection

In grounded theory, participant selection is a crucial step achieved through theoretical sampling, intentionally selecting suitable study participants. This process allows researchers to identify data collection needs by analyzing prior data to guide subsequent data collection within a specific context [33]. Following theoretical sampling methods, the next data collection targets were chosen based on the characteristics and quality of previously gathered data. By analyzing purposefully collected samples based on specific concepts, researchers can identify core concepts by extracting key attributes from study participants [30,33,34].

Data collection was conducted using face-to-face, individual, semi-structured interviews. The interviews were conducted by researchers who have worked in the G Mental Health Welfare Center for several years and previously worked as a nurse in the COVID-19 prevention center. Multidisciplinary experts participated in discussions to identify research participants. First, background information was assessed to determine participants’ availability for interviews. Next, to build rapport, researchers were introduced, psychological support guidelines were provided, participants’ written consent was obtained, and interviews were scheduled when convenient. Interviews were conducted in compliance with COVID-19 safety guidelines by a researcher who had previously worked in a COVID-19 prevention center.

Interviews began with open-ended questions and concluded with expressions of appreciation for participants’ engagement. The main interview questions were “As an independent small restaurant owner, what experiences have you gone through sequentially during the COVID-19 pandemic?” “What are your coping strategies during the COVID-19 pandemic?” and "What change did you feel through the COVID-19 pandemic?" The frequently used facilitation question was, “Is there anything else you would like to share regarding the COVID-19 experience as a small independent restaurant owner? If so, please tell us?” All interviews were audio-recorded. The interviewer summarized the content, asked participants to confirm it, and made debriefing notes after each interview. Thereafter, the researcher immediately transcribed the recorded content. The transcribed material was compared with the original recordings at least twice to ensure accuracy. The research team engaged in discussions regarding the analysis of the results, sharing their perspectives until a consensus was reached.

Data collection continued until theoretical saturation, occurring when categories are fully developed, densely interconnected, and yield no additional data. Herein, theoretical saturation was reached with the 15th participant, until no new concepts or themes were identified. Therefore, data collection was conducted until the 15th participant when the data no longer yielded new themes and sub-themes [30,33].

Data Analysis

Researchers use a constant comparison method to identify and classify data similarities and differences, extracting distinct categories for interpretation. Initially, an outline of the psychological pain of quarantined adults with COVID-19 histories was developed, carefully avoiding researcher bias. Transcripts were shared with participants for feedback and corrections. Data analysis followed Corbin and Strauss’s grounded theory methodology [30], with all transcripts reviewed using QSR NVivo11 for open coding.

Open coding assigns naming and categorizing phenomena by closely examining data in the initial coding phase. This process requires carefully repeated reviews of the raw data, allowing for a detailed analysis by comparing events and objects and employing theoretical comparison techniques. Using theoretical comparison techniques that contrast similar and differing concepts, we derive categories and identify unique attributes, grouping similar ideas into broader categories. Through open coding, specific concepts, sub-themes, and themes emerge from the raw data, clarifying their properties and dimensions.

In axial coding, previously distinct concepts and categories identified during open coding are reassembled to create a structural framework offering a more detailed and comprehensive explanation of the phenomenon being studied. This process involves linking categories through a paradigm model that incorporates essential elements from causal conditions to consequences.

Causal conditions are events that trigger or facilitate particular phenomena. Contextual conditions refer to a set of circumstances whereby particular phenomena are situated. Intervening conditions within a specific context can facilitate/inhibit the effectiveness of action/interaction strategies. Action/interaction strategies involve addressing, controlling, executing, and responding to phenomena. Consequences refer to the results stemming from action/interaction strategies.

In the selective coding phase, content at the descriptive level was developed to an abstract level. We identify a core category that represents concepts and categories. All categories were integrated into the core category using selective coding. Herein, this core category was the foundation for creating a theory focusing on the adaptation process of small independent restaurant owners during the COVID-19 pandemic. Accordingly, a theoretical framework was established, and a context-specific theory was derived.

Subsequently, process analysis was performed to examine how participants' experiences developed over time. It involves sequentially connecting stages, enabling an understanding of how the process evolves based on various factors and ultimately leading to specific outcomes.

Rigor

To ensure rigor, we applied Lincoln and Guba’s criteria of truth value, applicability, consistency, and neutrality[35]. The truth value was ensured through repeated checks and interpretations for accuracy. First, interdisciplinary researchers reviewed the interview transcripts, offering suggestions for rephrasing, interpreting, and confirming participants' experiences. Second, the members discussed the findings to analyze themes and expressions that impacted the results. Third, for a final check, the members shared supplementary feedback on the analysis. Data saturation and the validity of the analysis were further reinforced through reaffirmation by interdisciplinary researchers.

The applicability of the findings in different settings of the results was validated by obtaining feedback from three participants and three non-participants to enhance authenticity so that the results could be applied to a wider range of situations. A "maximum variation sampling" approach [36] was employed to recruit self-employed individuals across various sectors in South Korea who had sought online counseling due to COVID-19. Participants were selected through a recruitment notice posted at G Mental Health Welfare Center, with informed consent obtained after explaining the study’s purpose. Non-participants, who had years of business experience, empathized with the participants and shared their perspectives on the severity of the COVID-19 crisis. They emphasized the anxiety caused by strict government policies, the importance of contingency plans, and the key roles that restaurant operational strategies and location played in attracting customers during economic downturns. Research participants were asked to read the study results to verify their applicability to their own experiences. All interviewees were informed that their content would be reviewed by researchers and interdisciplinary experts. We repeatedly listened to the recorded interviews and transcribed them according to the participants' statements. Participant information remained confidential and was used solely for research. All interviews were transcribed in Microsoft Word, personal details were removed, and unique identification numbers were assigned to coding results to ensure anonymity. The anonymized data was shared with participants for verification. Researchers and experts then cross-checked the recordings and transcripts for accuracy.

Consistency was assessed through theoretical comparisons. Throughout the analysis, data and coding were regularly reviewed by researchers, nursing professors, and a psychologist. Neutrality was upheld by minimizing interactions between researchers and participants. To mitigate bias, we reviewed a broad spectrum of domestic and international literature on small business owners in the food service industry to minimize any preconceived notions held by the researchers.

Ethical Considerations

This study was approved by the Ethics Committee of Kyungpook National University (IRB No. 023-0630). The researchers thoroughly explained the study’s purpose, methodology, and participants' right to withdraw at any time without penalty. Written informed consent was obtained. All recorded data were stored in password-protected files, and physical documents were secured in a locked cabinet.

Results

The 15 participants were small independent restaurant owners affected by COVID-19 (Table 1). Six themes, 15 sub-themes, and 40 codes (Table 2) were identified.

Casual Condition: Operational Difficulties in Restaurants Affected by COVID-19

As COVID-19 cases surged, social distancing measures intensified to the highest level, significantly reducing gatherings and family dining outings. Initially, participants did not consider the situation particularly serious. However, as conditions prevailed, they gradually became more sensitive to media reports and recognized the severity of the COVID-19 crisis. For small independent restaurant owners, the financial damage caused by the pandemic was unavoidable.

1. Financial Insecurity Due to Decreased Income

Participants indicated that social distancing measures implemented in response to the COVID-19 pandemic resulted in reduced customer attendance. Initially, they did not foresee that COVID-19 would significantly affect sales. However, as accumulated losses from declining revenues increased, they experienced significant challenges regarding operating expenses.

"I have experienced nearly a year of inactivity due to the absence of customers. With no clear end to the COVID-19 pandemic and increasing deficits, I am very concerned about how to maintain my livelihood" (P3).

"As the economic downturn persisted after the outbreak, I lost many important clients, and it is no exaggeration to say that my life has been completely disrupted" (P10).

2. Growing Concerns Amid the Prolonged COVID-19

Without a clear indication of whether business suspensions would last for one or two months, they found themselves in increasingly precarious livelihood situations.

“Presently, the implementation of more stringent social distancing measures has resulted in a stifling environment. I really don’t know how we’re supposed to keep our businesses running under these circumstances” (P11).

“I’ve never experienced anything like this in my decades of running a business, and it leaves me feeling incredibly disoriented” (P6).

Contextual Condition: Bewilderment Due to Unprecedented Circumstances

As consumer spending dwindled and government restrictions on operations ensued, participants experienced bewilderment as neighboring establishments gradually shut down. Those who remained faced significant distress. Despite their earnest adherence to safety protocols, they voiced their dissatisfaction regarding inadequate governmental compensation.

1. Hierarchical Quarantine Policy That Requires Compliance

With ongoing COVID-19-related restrictions, participants encountered difficulties in managing their businesses due to declining revenues. They noted that non-compliance to government-mandated closing hours could lead to fines and their inoperability for several days. Additionally, they expressed their concerns about the frequent and inconsistent changes in health regulations, which seemingly lacked clear standards.

“Since the onset of COVID-19, small restaurant owners have faced significantly stricter regulations and oversight compared to other countries. I've heard of cases where individuals were fined merely for opening their restaurants after the designated hours, and some even had to deal with temporary shutdowns” (P12).

“Since we got the official notice prohibiting groups of five or more customers, the regulations have continuously changed. The constantly changing health guidelines are making it really difficult to run the restaurant” (P1).

2. Distress from Fixed Cost Burdens

Participants indicated that accumulated revenues due to COVID-19 made it increasingly challenging to cover fixed costs associated with running their businesses. Furthermore, the surge in delivery orders resulted in increased delivery fees and labor costs. With many workers shifting to delivery roles, participants faced labor shortages and rising wage demands.

“I'm continually grappling with costs like rent, utilities, and ingredients that just keep adding up. As the month ends, I can't help but feel dreadful about making the payment” (P7).

“Delivery fees and labor costs have skyrocketed. Nowadays, after covering the delivery app charges and delivery fees, I'm left in a deficit” (P5).

3. Discontent with Insufficient Support Systems

Participants stated the unavailability of organizations to provide assistance, noting that they frequently encountered considerable delays in contacting relevant department representatives. They expressed dissatisfaction with the financial aid, stating that the amounts offered were inadequate to cover their actual financial deficits. Moreover, the application process for these funds was perceived as complicated, leading to prolonged wait times for compensation.

“Many times, the representatives give inconsistent and irrelevant responses. They often seem unsure about the correct information, which can be very frustrating” (P15).

“The financial aid is inadequate to keep a shop running for a full year, and the application criteria are strict, with lengthy approval wait times” (P4).

Central Phenomenon: A Life Shattered by COVID-19

The widespread impact of COVID-19 across the nation has disrupted daily operations, and the continuously declining revenues have led them to consider closing their businesses.

1. Pressure from Threats to Survival

Some participants stated that COVID-19-ensuing financial difficulties intensified their burdens, leading them to consider the possibility of closing their businesses, with few options other than to passively monitor the situation.

“Efforts to attract customers have led to tepid responses, while the continuous advertising costs are steadily depleting financial resources” (P13).

“I did not foresee COVID-19 affecting small businesses like mine. If this situation persists, I may need to consider closing the business” (P14).

2. Burden of Living in Exacerbating Circumstances

Participants acknowledged their responsibility regarding following guidelines aimed at preventing the spread of COVID-19 but expressed increasing frustration over restrictions that negatively affected their businesses.

“We can currently serve only one table at lunchtime after COVID-19, leading to concerns that the situation may deteriorate further” (P5).

“Frequent social distancing has made deserted streets in the evenings a typical sight” (P8).

Intervening Condition: Enduring Adversity Through Hope

For participants, the COVID-19 crisis seemed like navigating through a dark tunnel. However, they began to recognize that some small independent restaurant owners had successfully transformed the crisis into an opportunity. Through their experiences of navigating recurring crises, participants recognized that utilizing their acquired knowledge and available support resources could help them endure the difficulties encountered. This awareness fostered the belief that with determination and effort, they could overcome these challenges.

1. Gradually Accustomed to Crisis Situations

Participants adjusted to the ongoing crisis, garnering internal strength through accumulated crisis management skills. The longer they persisted, the more confident they became. Repeated challenges honed their personal crisis-response strategies, fostering resilience to manage difficult situations.

“As time went on and I managed to keep my store open, I gradually gained confidence and maintained my resilience” (P11).

“With my long experience in the restaurant industry, I'm looking to adapt to the changes brought by COVID-19. As my restaurant is situated near a university, I'm currently focusing on developing fusion dishes that I believe will appeal to young students” (P7).

2. Support Resources That act as a Backbone

Participants expressed gratitude to family members who believed in them and offered support during the COVID-19 pandemic. They noted that social gatherings helped relieve stress and provided valuable opportunities to exchange information with others in the food industry. Financial aid also proved helpful in sustaining their livelihoods.

“Having a loving family has been a tremendous source of strength, helping me get through tough times” (P1).

“Sharing insights and information on recent market trends with fellow members of the food industry networking group has been an invaluable experience” (P13).

“As the administrative systems began to stabilize over time, I was able to receive fair compensation and a low-interest loan based on my health insurance costs” (P15).

Action/Interactional Strategy: Ongoing Struggles in the Face of the Hardships

Small restaurant owners experience a constant struggle for survival. To overcome these challenges, they focused on the positive aspects of their situations, actively pursued new business opportunities, and participated in organized protests.

1. Starting Anew with a New Mindset

Over time, participants endeavored to accept their reality. Despite moments of frustration stemming from negative circumstances, they sought to alleviate stress through their own coping methods.

“I truly believe that if we persist and don’t give up, we can transform this crisis into an opportunity, as everyone in the food service industry is exerting their best effort during these challenging times” (P11).

“Having friends to share my hobby with really energizes me, especially compared to spending lonely weekends at home” (P7).

2. Seeking New Breakthroughs

They began searching for commercial areas with potential for profit despite the pandemic, preparing to adapt to the changing circumstances. Furthermore, they ventured to grasp market trends by consulting local merchants.

“We also began offering food delivery and accepting pre-orders instead of only serving sushi for dine-in customers” (P11).

“We’ve been spending a lot on advertising to ensure our restaurant name appears at the top of delivery app listings” (P15).

3. Commitment to Making Every Possible Effort

To offset revenue losses, some participants made extra efforts besides their main business activities. Several gathered in front of the city hall, holding signs voicing their grievances, both individually and collectively.

“I spent my nights taking quick naps in the corner of my shop, and I’ve been delivering services on my motorcycle after closing the restaurant” (P8).

“We are working together to express our stance through peaceful protest activities. It is not a problem for us to peacefully express our feelings by gathering in black raincoats on the streets or participating in group walks during operating restrictions” (P11).

Consequences: Fostering Resilience Amid Feelings of Helplessness

Most participants closed their businesses due to losses. The crisis transformed many aspects of life, prompting small independent restaurant owners to reflect on their successes and failures and grow.

1. Despair Due to Overwhelming Realities

Participants hoped for realistic compensation after the onset of the COVID-19 pandemic. However, the government required sacrifices from small restaurant owners without providing compensation or viable solutions, heightening concerns about managing their livelihoods in the aftermath of the pandemic.

“In the past two years, the only support I received from the government was an emergency loan and initial compensation for COVID-19 losses. Restaurants can no longer bear the current burden” (P15).

“The decision to ban operations after 9 PM has made it nearly impossible for us to keep the restaurant open” (P10).

2. Life of Sustaining and Persevering

Some participants believed that the challenges they faced would be resolved. They noted that the food service industry was their chosen field, aligned with their skills, and a vital part of their livelihood.

“I believe that keeping my store running during such tough times is an achievement in itself” (P2).

“I don’t have any skills beyond making bread, as I’ve been in the bakery business for a long time. My primary goal is to continue managing my bakery as I currently do” (P4).

3. Reborn as a Responsible Agent

Participants were actively researching ways to improve taste and service, developing their own paths. They shared that challenging efforts and perseverance engendered new directions and significant personal growth.

“The new lunch box I created has received positive feedback from busy office workers. After months of development, I've finally generated enough revenue to sustain my store” (P9).

“I continually review and revise my business plan while striving to live faithfully. I've learned to face significant challenges with patience during crises and to hold onto hope in despair” (P3).

Process Analysis

The key category identified was the struggle for survival in blind spots of uncertainty and helplessness. The strategic coping process followed fourth stages: recognizing an intensified sense of crisis and despair from a harsh reality, seeking new coping strategies, and fostering resilience (Figure 1).

1) Recognizing an Intensified Sense of Crisis

The unprecedented, life-threatening nature of the pandemic intensified this fear, with the financial hardship affecting their physical and mental well-being.

2) Despair from a Harsh Reality

The forced closures of their restaurants triggered financial strain and mental exhaustion, resulting in stress and anxiety deriving from worsening circumstances.

3) Seeking New Coping Strategies

Some have renovated their spaces, taken on side jobs, and closely monitored delivery app feedback to make necessary improvements to enhance their restaurants.

4) Fostering Resilience

The knowledge and resilience gained from repeated challenges during the pandemic have facilitated overcoming adversity.

Discussion

This study explored the experiences of small independent restaurant owners during the COVID-19 pandemic through qualitative research based on grounded theory. The key category identified was the struggle for survival in the blind spot of uncertainty and helplessness. We found that participants used varied coping strategies to confront these challenges.

Operational difficulties in restaurants affected by COVID-19 emerged as a casual condition, as owners had not anticipated the pandemic’s prolonged impact. A study measuring emotional stress—using indicators such as anger, anxiety, and depression—found significant increases compared to pre-pandemic levels, highlighting the crisis's detrimental effects on psychological well-being [37-39]. Therefore, an integrated, multi-faceted approach to mental health crisis management and psychological support policies is essential for small business owners in the food service industry. The government has established the "New Virus Integrated Psychological Support Group," led by regional mental health welfare centers, to provide psychological support for COVID-19 victims [40]. However, the current government-led mental health policies primarily focus on infected individuals, offering insufficient support for economically vulnerable groups, such as small independent restaurant owners. Thus, targeted strategies are essential to support their mental health, prevent suicide, and address their unique vulnerabilities. It is crucial to actively engage with small business owners affected by quarantine measures and social distancing while mobilizing and integrating community health and welfare resources to promote mental well-being through regional mental health welfare centers. Additionally, expanding community-based integrated mental health care services that combine psychiatric treatment and mental health welfare through regional mental health welfare centers would be a more effective approach. Through regional mental health welfare centers, nursing-centered policy combined with the reinforcement of therapeutic communication outlets, is essential for identifying crisis origins. Furthermore, mental health education and practical support provided by mental health welfare centers and nurses should be implemented to minimize the psychological and emotional harm caused by COVID-19.

In the contextual condition, bewilderment due to unprecedented circumstances emerged as an upper theme. A survey of small business owners in essential industries, including the restaurant sector, predicted declining sales and net profits in 2022 [26,40]. The restriction of operating hours after 9 p.m. was particularly criticized for its detrimental impact on sales. The crisis faced by them is closely linked to structural challenges, including limited access to compensation and gaps in institutional support systems. This aligns with research highlighting inadequacies in the domestic welfare system, which fails to address emerging social risks [41,42]. To support small business owners in the food service industry, regional mental health welfare centers must play a key role in establishing a resilient and sustainable social safety net in preparation for unpredictable situations like the COVID-19 pandemic. Previous study indicates that the most significant challenges faced by small business owners in Ulsan during the COVID-19 pandemic were a decrease in income and difficulties in managing their businesses [10]. Specifically, small business owners in sectors such as food services reported the greatest disruptions to their daily lives. These financial setbacks have also led to a rise in mental health issues, including anxiety, depression, stress, and sleep disturbances. To address these issues, it is essential to connect a basic economic safety net by regional mental health welfare centers as part of a broader social security framework. Without such a safety net, the collapse of small businesses will likely lead to the creation of another vulnerable socio-economic group. Therefore, it is essential to create a social safety net, centered around local mental health welfare centers, that offer ongoing economic and psychological support to small business owners, enabling long-term mutual sustainability in response to the prolonged economic crisis.

In the central phenomenon, life shattered by COVID-19 emerged as an upper theme. Participants described experiencing overwhelming existential threats and helplessness, leading to severe psychosocial distress. This highlights the profound challenges faced by small restaurant owners, who struggle with unforeseen crises beyond their control. Many recalled that, unlike the relatively short-lived MERS outbreak, COVID-19’s prolonged impact, compounded by new variants and recurrent surges, intensified their anxiety [43-45]. Therefore, it is crucial to develop alternative psychological support service models, such as low-contact (low-tact) or non-contact (un-tact) approaches, to effectively respond to the spread of infectious diseases led by regional mental health welfare centers. Recently, various sectors of South Korea's business industry have been actively and continuously striving to explore un-tact solutions in response to the spread of infectious diseases. However, both the government and local authorities have shown limited interest in developing alternative service models, such as low-contact and un-tact approaches, to provide social welfare services and psychological support to vulnerable groups, such as independent small restaurants, which have been severely impacted by COVID-19 [10,40]. Therefore, based on the results of this study, it is recommended that mental health welfare centers in each region independently develop and operate a broader range of alternative psychological support service models, such as home-visit and un-tact services, for vulnerable citizens like small business owners. The activation of such alternative psychological support services is expected to prevent the isolation of vulnerable groups, such as small independent restaurant owners while ensuring greater accessibility to mental health services and actively responding to the increasing demand for mental health support. The development of various alternative psychological support service models requires a proactive approach in securing and allocating budgets. Furthermore, it is vital to ensure a strong commitment to implementation, particularly through collaboration with relevant organizations centered around regional mental health welfare centers.

In the intervening condition, enduring adversity with hope emerged as an upper theme. This study found that participants gradually adapted to the unfamiliar environment and challenges of the COVID-19 crisis by employing various coping strategies. This finding aligns with previous research indicating that while individuals initially struggled to adapt to sudden changes, they eventually developed coping strategies and resilience over time [45,46]. To overcome the psychological trauma caused by the spread of COVID-19, it is essential to develop alternative models in the areas of education, culture, tourism, sports, and religion, centered around mental health welfare centers. In particular, the private sectors such as services, education, culture, tourism, sports, and religion are easily accessible, making it easier to promote and implement alternative psychological support models for overcoming COVID-19. This implies the necessity for essential psychosocial interventions that focus on providing hope, safety, tranquility, and social connection to help reduce anxiety, depression, and stress in these private centers. By establishing platforms that encourage and support innovative approaches in these private sectors led by regional mental health welfare centers, we could enhance the mental well-being of vulnerable groups, including small independent restaurant owners, even amid the new reality of infectious disease outbreaks. This would also contribute to mitigating the negative social consequences arising from the economic downturn and stagnation in these sectors. Thus, developing a structured nursing support framework led by regional mental health welfare centers in these private sectors can help individuals to connect with support sources more effectively.

For action-interactional strategies, ongoing struggles in the face of hardships emerged as an upper theme. Small independent restaurant owners strived to manage unpredictable challenges by leveraging their coping mechanisms and available resources. This aligns with previous studies suggesting that individuals actively seek solutions during crises [46]. The findings emphasize the need to assess the effectiveness of support measures and develop targeted nursing interventions to mitigate the social risks for small independent restaurant owners. At the community level, implementing an integrated support policy that combines medical treatment for local residents is essential. Therefore, it is essential to connect and mobilize community health and welfare resources. Additionally, expanding integrated community mental health services that combine both medical and welfare support through mental health welfare centers is crucial. For example, this approach was demonstrated through the existing case management teams in Ulsan’s five districts, which coordinate efforts between community mental health welfare centers and psychiatric institutions [10]. These teams would serve as the foundation for assessing and diagnosing COVID-19-related concerns, developing intervention strategies, and overseeing service implementation. It proved that regional mental health welfare centers could function as control hubs. This framework represents a structured integration of healthcare and welfare services. By expanding mental health and welfare services to theses underserved populations, this system would enhance responsiveness to pandemic-induced psychological distress, and incorporate findings into policy development for improved support measures.

As a consequence of utilizing action-interactional techniques, the experiences of small restaurant owners during the COVID-19 crisis were categorized into three themes: sustaining and persevering, rebirth as responsible agents, and despair due to overwhelming realities. Participants who successfully navigated significant challenges demonstrated strong social support and resilience. They adopted a realistic approach to stress, employing problem-focused coping strategies and actively seeking solutions. This aligns with prior research indicating that small restaurant owners utilized strategies such as menu innovation, cost-cutting, social media marketing, and delivery service partnerships to mitigate economic challenges [42]. In contrast, participants in the despair group had limited social support and low resilience. They tended to suppress negative emotions, delay problem-solving, and rely on avoidant coping strategies. This finding is consistent with previous studies showing that economic strain from COVID-19 contributed to psychological trauma and increased stress levels among small business owners, particularly in the food service sector [45,46]. The findings of this study reveal that the mental health status and sleep patterns of small business owners are critically concerning. Many participants are considered to be at high risk of suicide. Therefore, regional mental health welfare centers must take the lead in assessing the situations of vulnerable groups, such as small independent restaurant owners, during future crises like COVID-19. Furthermore, ongoing monitoring and proactive management of mental health issues, particularly those related to suicide risk, are essential. Finally, regional mental health welfare centers are required to enhance the mental health of small independent restaurant owners through more active promotion of suicide prevention initiatives and mental health services. For example, programs such as the "High-Risk Group Medical Institution Referral Service," "Mobile Mental Health Counseling," "Citizen Participation Online Campaign," and "COVID-19 Psychological Support Information Provision," led by the regional mental health welfare centers and other related institutions are required to expand outreach and support for small independent restaurant owners.

The strengths of this study include direct interviews with small independent restaurant owners impacted by the COVID-19 pandemic, along with comprehensive data analysis. The findings provide a valuable foundation for future psychological research in this area. Collaboration with interdisciplinary researchers facilitates a more holistic examination of post-COVID-19 strategies. By highlighting the unique lived experiences of these business owners, this study offers insights into developing innovative coping mechanisms and enhancing mental health services for high-risk populations affected by the pandemic. The study has several limitations, particularly related to sampling. While COVID-19 was a global crisis, the data collection was limited to a specific geographic region, potentially limiting its applicability in a global context. Furthermore, as the study primarily involved mental health professionals, future research should integrate a broader range of multidisciplinary experts to provide more comprehensive insights. Finally, additional long-term studies are necessary to assess the lasting impact of COVID-19 on small independent restaurant owners.

Conclusion

This study offers valuable insights into the challenges faced by small independent restaurant owners during the COVID-19 pandemic. These owners, particularly vulnerable to the pandemic’s impact, experienced significant emotional and physical hardships. While initially expressing negative emotions, participants gradually adapted to the "new normal" and demonstrated resilience. The findings emphasize the need for timely psychological interventions to alleviate distress and promote positive change. Nursing professionals should develop comprehensive support programs for restaurant industry owners to enhance their resilience. Given that the data was limited to one geographical area, future research should expand internationally to better represent small independent restaurant owners globally during the pandemic.

Figure 1.

“The struggle for survival under the blind spot of uncertainty and helplessness” Paradigm Model

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Figure & Data

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