Pighin S, Tentori K. Public's understanding of swab test results for SARS-CoV-2: an online behavioural experiment during the April 2020 lockdown.
BMJ Open 2021;
11:e043925. [PMID:
33455939 PMCID:
PMC7813337 DOI:
10.1136/bmjopen-2020-043925]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/29/2020] [Accepted: 12/14/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE
Although widespread testing for SARS-CoV-2 is in place, little is known about how well the public understands these results. We aimed to provide a comprehensive overview of the general public's grasp of the accuracy and significance of the results of the swab test.
DESIGN
Web-based behavioural experiment.
SETTING
Italy during the April 2020 lockdown.
PARTICIPANTS
566 Italian residents.
MAIN OUTCOME MEASURES
Participants' estimates of the SARS-CoV-2 prevalence; the predictive and diagnostic accuracy of the test; the behavioural impact of (positive vs negative) test results; the perceived usefulness of a short-term repetition of the test following positive or negative results; and rankings of causes for false positives and false negatives.
RESULTS
Most participants considered the swab test useful (89.6%) and provided predictive values consistent with their estimates of test diagnostic accuracy and infection prevalence (67.0%). Participants acknowledged the effects of symptomatic status and geographical location on prevalence (all p<0.001) but failed to take this information into account when estimating the positive or negative predictive value. Overall, test specificity was underestimated (91.5%, 95% CI 90.2% to 92.8%); test sensitivity was overestimated (89.7%, 95% CI 88.3% to 91.0%). Positive results were evaluated as more informative than negative ones (91.6, 95% CI 90.2 to 93.1 and 41.0, 95% CI 37.9 to 44.0, respectively, p<0.001); a short-term repetition of the test was considered more useful after a positive than a negative result (62.7, 95% CI 59.6 to 65.7 and 47.2, 95% CI 44.4 to 50.0, respectively, p=0.013). Human error and technical characteristics were assessed as more likely to be the causes of false positives (p<0.001); the level of the viral load as the cause of false negatives (p<0.001).
CONCLUSIONS
While some aspects of the swab for SARS-CoV-2 are well grasped, others are not and may have a strong bearing on the general public's health and well-being. The obtained findings provide policymakers with a detailed picture that can guide the design and implementation of interventions for improving efficient communication with the general public as well as adherence to precautionary behaviour.
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