Understanding Barriers and Facilitators to Compliance with UK Social Distancing Guidelines During the COVID-19 Pandemic: A Qualitative Interview Study

Implementing an educational resource for patients participating in cancer clinical trials during the pandemic

This research is centred in the specialty of early phase cancer research - the branch of clinical research that focuses on phase one and phase two clinical trials. The aim was to gain an understanding of the complexity of work involved in implementing an educational intervention within the clinical pathway for newly referred early phase cancer clinical trial patients. The May and Finch Normalisation Process Theory (NPT) was used to understand, develop and evaluate the process of embedding an educational resource at referral hospital sites. Elements emerged from the evaluation that provide insights into the complexity of the implementation work that took place. The main elements were: pandemic-related challenges, change management, leadership, shared purpose, teamwork, workforce capacity and patient outcomes. The findings shed light on the barriers to or facilitators of the implementation of the educational resource.

Decision to self-isolate during the COVID-19 pandemic in the UK: a rapid scoping review

OBJECTIVE

Testing for COVID-19 was a key component of the UK's response to the COVID-19 pandemic. This strategy relied on positive individuals self-isolating to reduce transmission, making isolation the lynchpin in the public health approach. Therefore, we scoped evidence to systematically identify and categorise barriers and facilitators to compliance with self-isolation guidance during the COVID-19 pandemic in the UK, to inform public health strategies in future pandemics.

DESIGN

A rapid scoping review was conducted.

SEARCH STRATEGY

Key terms were used to search literature databases (PubMed, Scopus and the WHO COVID-19 Research Database, on 7 November 2022), Google Scholar and stakeholder-identified manuscripts, ultimately including evidence published in English from UK-based studies conducted between 2020 and 2022.

DATA EXTRACTION AND SYNTHESIS

Data were extracted and synthesised into themes, organised broadly into capability, opportunity and motivation, and reviewed with key stakeholders from the UK Health Security Agency (UKHSA).

RESULTS

We included 105 sources, with 63 identified from UKHSA and used to inform their decision-making during the pandemic. Influences on the decision to comply with isolation guidance were categorised into six themes: perceived ability to isolate; information and guidance; logistics; social influences, including trust; perceived value; and perceived consequences. Individuals continuously assessed these factors in deciding whether or not to comply with guidance and self-isolate.

CONCLUSIONS

Decisions to self-isolate after a positive test were influenced by multiple factors, including individuals' beliefs, concerns, priorities and personal circumstances. Future testing strategies must facilitate meaningful financial, practical and mental health support to allow individuals to overcome the perceived and actual negative consequences of isolating. Clear, consistent communication of the purpose and procedures of isolating will also be critical to support compliance with self-isolation guidance, and should leverage people's perceived value in protecting others. Building public trust is also essential, but requires investment before the next pandemic starts.

Umgang mit subjektiv erlebten Coronarisiken: Sichtweisen junger chronisch kranker Erwachsener

Hintergrund

Junge Erwachsene mit chronischen Erkrankungen gelten als Gruppe, die durch Corona gefährdet ist. Ob und wie die Betroffenen sich zu schützen versuchen, welche Risikowahrnehmungen sie verdeutlichen und wie der Lockdown erlebt wird, dazu mangelt es an Erkenntnissen primär im deutschen Sprachraum.

Ziele und Fragestellung

Im Beitrag wird analysiert, welches Coronaschutzverhalten junge chronisch kranke Erwachsene berichten, welche Risikowahrnehmungen sie aufweisen und wie sie den Lockdown erleben.

Material und Methoden

Mit n = 59 jungen Erwachsenen (häufig Studierende oder Auszubildende), die von Typ‑1-Diabetes (n = 16), Krebs (n = 18), chronisch-entzündlichen Darmerkrankungen (n = 21) oder von bestimmten seltenen, komplexen Erkrankungen (n = 4) betroffen sind, wurden episodische Interviews geführt. Die Datenauswertung erfolgt mittels thematischen Kodierens.

Ergebnisse

Wenige Befragte meinen, durch Corona kaum persönlich gefährdet zu sein, so dass auch Schutzmaßnahmen wie Impfungen sekundär sind. Die meisten Interviewten jedoch berücksichtigen Schutzmaßnahmen penibel. Sie können sich hierzu entweder verpflichtet fühlen, um z. B. andere vulnerable Personen zu schützen, oder sie erleben sich als sehr anfällig für schwere Coronainfektionen. Ungeachtet von erlebten Einschränkungen im Lockdown ist dieser für viele Interviewte auch mit neuen Möglichkeiten verbunden. Online-Formate erleichtern ihnen, Studium/Ausbildung trotz chronischer Erkrankung fortzusetzen und Kontakte mit Freund*innen zu halten.

Schlussfolgerung

Coronarisikowahrnehmungen und Schutzverhalten junger chronisch kranker Erwachsener sollten in ihrem subjektiven Sinn verstärkt in der Versorgung und Begleitung dieser Zielgruppen berücksichtigt werden. Hybride Lehre sollte über den Lockdown hinaus beibehalten werden, damit die jungen Erwachsenen trotz ihrer chronischen Erkrankung sozial teilhaben können und zugleich vor Corona- und weiteren Infektionen geschützt sind.

Environmental determinants of infectious and chronic disease prevention behaviours: A systematic review and thematic synthesis of qualitative research

Regulatory health policies facilitate desired health behaviours in communities, and among them, smoke-free policies and COVID-19 restrictions have been widely implemented. Qualitative research studies have explored how these measures and other environmental influences shape preventive behaviours. The objective of this systematic review was to synthesize previously published qualitative research, generate across-study themes, and propose recommendations for behaviour change interventions. We used a comprehensive search strategy, relevance screening and confirmation, data extraction, quality assessment, thematic synthesis, and quality-of-evidence assessment. In total, 87 relevant studies were identified. Findings were grouped under six overarching themes and mapped under three categories: (i) the political environment, (ii) the sociocultural environment, and (iii) the physical environment. These findings provide insights into the environmental influences of behaviour and indicate future interventions may be more effective by considering moral norms, community norms, policy support, and group identity.

Physical Activity during the COVID-19 Pandemic in the UK: A Qualitative Analysis of Free-Text Survey Data

BACKGROUND

Several quantitative studies have found a decline in physical activity in response to COVID-19 pandemic restrictions. The aim of the present study was to use large-scale free text survey data to qualitatively gain a more in-depth understanding of the impact of the COVID-19 pandemic on physical activity, then map barriers and facilitators to the Capability, Opportunity, Motivation, and Behaviour (COM-B) Model of Behaviour to aid future intervention development.

METHODS

17,082 participants provided a response to the free text module, and data from those who mentioned a physical activity related word in any context were included. Data were analysed using thematic analysis and key themes identified.

RESULTS

5396 participants provided 7490 quotes related to physical activity. The sample were predominately female (84%), white (British/Irish/Other) (97%) and aged <60 years (57%). Seven key themes were identified: the importance of outdoor space, changes in daily routine, COVID-19 restrictions prevented participation, perceived risks or threats to participation, the importance of physical health, the importance of physical activity for mental health and the use of technology.

CONCLUSION

Future physical activity interventions could encourage people to walk outdoors, which is low cost, flexible, and accessible to many. Developing online resources to promote and support physical activity provides a flexible way to deliver quality content to a large audience.

Exploring Barriers and Facilitators to Physical Activity during the COVID-19 Pandemic: A Qualitative Study

Quantitative data show that physical activity (PA) reduced during the COVID-19 pandemic, with differential impacts across demographic groups. Qualitative research is limited; thus, this study aimed to understand barriers and facilitators to PA during the pandemic, focusing on groups more likely to have been affected by restrictions, and to map these onto the capability, opportunity, motivation model of behaviour (COM-B). One-to-one interviews were conducted with younger (aged 18–24) and older adults (aged 70+), those with long-term physical or mental health conditions, and parents of young children. Themes were identified using reflexive thematic analysis and were mapped onto COM-B domains. A total of 116 participants contributed (aged 18–93, 61% female, 71% White British). Key themes were the importance of the outdoor environment, impact of COVID-19 restrictions, fear of contracting COVID-19, and level of engagement with home exercise. Caring responsibilities and conflicting priorities were a barrier. PA as a method of socialising, establishing new routines, and the importance of PA for protecting mental health were motivators. Most themes mapped onto the physical opportunity (environmental factors) and reflective motivation (evaluations/plans) COM-B domains. Future interventions should target these domains during pandemics (e.g., adapting PA guidance depending on location and giving education on the health benefits of PA).

Feasibility and acceptability of daily testing at school as an alternative to self-isolation following close contact with a confirmed case of COVID-19: a qualitative analysis

BACKGROUND

Daily testing using a rapid Lateral Flow Device (LFD) has been suggested as an alternative to self-isolation. A randomised trial comparing daily contact testing (DCT) in schools with self-isolation found that SARS-CoV-2 transmission within school was comparable and low in both groups. However, if this approach is to be adopted widely, it is critical that we understand the perspective of those who will be delivering and receiving DCT. The aim of this qualitative process study embedded in the randomised controlled trial (RCT) was to improve understanding of a range of behavioural factors that could influence implementation.

METHODS

Interviews were conducted with 63 participants, including staff, students, and parents of students who had been identified as being in close contact with someone with COVID-19. The topic guide explored perceptions of daily testing, understanding of positive and negative test results, and adherence to guidance. Data were analysed using an inductive thematic approach.

RESULTS

Results were organised under three main headings: (1) factors influencing daily testing (2) interpretation of test results (3) behaviour during testing period. Participants recognized that daily testing may allow students to remain in school, which was viewed as necessary for both education and social needs. Whilst some felt safer as a result of daily testing, others raised concerns about safety. Participants did not always understand how to interpret and respond to test results, and although participants reported high levels of adherence to the guidance, improved communications were desired.

CONCLUSION

Daily testing may be a feasible and acceptable alternative to self-isolation among close contacts of people who test positive. However, improved communications are needed to ensure that all students and parents have a good understanding of the rationale for testing, what test results mean, how test results should be acted on, and how likely students are to test positive following close contact. Support is needed for students and parents of students who have to self-isolate and for those who have concerns about the safety of daily testing.