1
|
De Brochowski V, Rubin GJ, Webster RK. The effect of nocebo explanation and empathy on side-effect expectations of medication use following a fictional GP consultation. PSYCHOL HEALTH MED 2024; 29:809-821. [PMID: 37491019 DOI: 10.1080/13548506.2023.2240072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
The simple act of informing patients about side-effects increases the likelihood they will experience them (i.e. the nocebo effect). Explaining this psychological phenomenon could help to reduce side-effect experience, however, it is yet to be explored if this can be applied to clinical settings where new medication is prescribed. In addition, the degree to which a health-care provider empathetically communicates this to patients may have an impact. To investigate this, we carried out 2 × 2 factorial trial to assess the effect of nocebo explanation and empathy (plus their interaction) on side-effect expectations following a fictional GP consultation prescribing a new medication. Overall, 208 participants were randomised to watch one of the four fictive GP consultations and play the role of the patient. In all videos, participants received information about the reason for the consultation, the recommendation of a new fictive medicine, how to take it, benefits and side-effects. The videos differed in whether the GP provided an explanation of the nocebo effect (yes/no) and whether they communicated in an empathetic style (yes/no). After watching the video, participants were asked about their side-effect expectations and rated the quality of the GP's communication. Two-way ANOVAs revealed no main effect of nocebo explanation on expectation of side-effects warned or not warned about in the consultation. However, there was a main effect of empathy, with participants watching the empathetic consultations having significantly lower expectations of non-warned-about side-effects. There was no significant interaction. Findings suggest that explaining the nocebo effect and GP empathy did little to allay expectations of side-effects that were specifically mentioned in the consultation. However, GP empathy had an effect by helping to reduce additional side-effect expectations participants still had. Future work should extend these findings to real GP consultations where the full dimensions of empathy can be explored.
Collapse
Affiliation(s)
- Valentine De Brochowski
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - G James Rubin
- Health Protection Research Unit in Emergency Preparedness and Response at, King's College London, London, United Kingdom
| | | |
Collapse
|
2
|
Smith LE, West R, Potts HWW, Amlôt R, Fear NT, Rubin GJ, Michie S. Factors associated with wearing a facemask in shops in England following removal of a legal requirement to do so during the COVID-19 pandemic. Br J Health Psychol 2024; 29:3-19. [PMID: 37537895 DOI: 10.1111/bjhp.12684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/30/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES We aimed to identify psychological factors associated with the use of facemasks in shops in England following removal of legal requirements to do so, and to compare associations with and without legal restrictions. DESIGN Repeated cross-sectional online surveys (n ≈ 2000 adults) between August 2020 and April 2022 (68,716 responses from 45,682 participants) using quota sampling. METHODS The outcome measure was whether those who had visited a shop for essentials in the previous seven days reported always having worn a facemask versus sometimes or not at all. Psychological predictor variables included worry, perceived risk and severity of COVID-19 and the perceived effectiveness of facemasks. Socio-demographic variables and measures of clinical vulnerability were also measured. For the period following removal of legal restrictions, multivariable regression was used to assess associations between the primary outcome variable and predictors adjusting for socio-demographic and clinical vulnerability measures. The analysis was repeated including interactions between psychological predictors and presence versus absence of legal restrictions. RESULTS Worry about COVID-19, beliefs about risks and severity of COVID-19 and effectiveness of facemasks were substantially and independently associated with the use of facemasks. Removal of legal obligations to wear facemasks was associated with a 25% decrease in wearing facemasks and stronger associations between psychological predictors and wearing facemasks. CONCLUSIONS Legal obligations increase rates of wearing a facemask. Psychological factors associated with wearing a facemask could be targets for interventions aiming to alter rates of wearing a facemask. These interventions may be more effective when there are no legal obligations to wear a face covering in place.
Collapse
Affiliation(s)
- Louise E Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, UK
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
- Behavioural Science and Insights Unit, UK Health Security Agency, London, UK
| | - Nicola T Fear
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
| | - G James Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| |
Collapse
|
3
|
May T, Towler L, Smith LE, Horwood J, Denford S, Rubin GJ, Hickman M, Amlôt R, Oliver I, Yardley L. Mpox knowledge, behaviours and barriers to public health measures among gay, bisexual and other men who have sex with men in the UK: a qualitative study to inform public health guidance and messaging. BMC Public Health 2023; 23:2265. [PMID: 37978506 PMCID: PMC10655366 DOI: 10.1186/s12889-023-17196-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The 2022-23 mpox epidemic is the first-time sustained community transmission had been reported in countries without epidemiological links to endemic areas. During that period, the outbreak almost exclusively affected sexual networks of gay, bisexual, or other men who have sex with men (GBMSM) and people living with HIV. In efforts to control transmission, multiple public health measures were implemented, including vaccination, contact tracing and isolation. This study examines knowledge, attitudes, and perceptions of mpox among a sample of GBMSM during the 2022-23 outbreak in the UK, including facilitators for and barriers to the uptake of public health measures. METHODS Interviews were conducted with 44 GBMSM between May and December 2022. Data were analysed using reflexive thematic analysis. Positive and negative comments pertaining to public health measures were collated in a modified version of a 'table of changes' to inform optimisations to public health messages and guidance. RESULTS Most interviewees were well informed about mpox transmission mechanisms and were either willing to or currently adhering to public health measures, despite low perceptions of mpox severity. Measures that aligned with existing sexual health practices and norms were considered most acceptable. Connections to GBMSM networks and social media channels were found to increase exposure to sexual health information and norms influencing protective behaviours. Those excluded or marginalized from these networks found some measures challenging to perform or adhere to. Although social media was a key mode of information sharing, there were preferences for timely information from official sources to dispel exaggerated or misleading information. CONCLUSIONS There are differential needs, preferences, and experiences of GBMSM that limit the acceptability of some mitigation and prevention measures. Future public health interventions and campaigns should be co-designed in consultation with key groups and communities to ensure greater acceptability and credibility in different contexts and communities.
Collapse
Affiliation(s)
- Tom May
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK.
- School of Psychological Science, University of Bristol, Bristol, UK.
- Bristol Medical School, University of Bristol, Bristol, UK.
| | - Lauren Towler
- School of Psychological Science, University of Bristol, Bristol, UK
- School of Psychology, University of Southampton, Southampton, UK
| | - Louise E Smith
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jeremy Horwood
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Sarah Denford
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - G James Rubin
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Hickman
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
- United Kingdom Health Security Agency, Chief Scientific Officer's Group, London, UK
| | - Isabel Oliver
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- United Kingdom Health Security Agency, Chief Scientific Officer's Group, London, UK
| | - Lucy Yardley
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
- School of Psychological Science, University of Bristol, Bristol, UK
- School of Psychology, University of Southampton, Southampton, UK
| |
Collapse
|
4
|
Robin C, Reynolds R, Lambert H, Hickman M, Rubin GJ, Smith LE, Yardley L, Cai S, Zhang T, Mook P, McManus O, Lasseter G, Compston P, Denford S, Zhang J, Amlôt R, Oliver I. Understanding adherence to self-isolation in the first phase of the COVID-19 pandemic in England: a cross-sectional mixed-methods study. BMC Public Health 2023; 23:2074. [PMID: 37872611 PMCID: PMC10594856 DOI: 10.1186/s12889-023-16674-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/31/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND During the early "containment" phase of the COVID-19 response in England (January-March 2020), contact tracing was managed by Public Health England (PHE). Adherence to self-isolation during this phase and how people were making those decisions has not previously been determined. The aim of this study was to gain a better understanding of decisions around adherence to self-isolation during the first phase of the COVID-19 response in England. METHODS A mixed-methods cross sectional study was conducted, including an online survey and qualitative interviews. The overall pattern of adherence was described as never leaving home, leaving home for lower-contact reasons and leaving home for higher-contact reasons. Fisher's exact test was used to test associations between adherence and potentially predictive binary factors. Factors showing evidence of association overall were then considered in relation to the three aspects of adherence individually. Qualitative data were analysed using inductive thematic analysis. RESULTS Of 250 respondents who were advised to self-isolate, 63% reported not leaving home at all during their isolation period, 20% reported leaving only for lower-contact activities (dog walking or exercise) and 16% reported leaving for higher-contact, and therefore higher-risk, reasons. Factors associated with adherence to never going out included: the belief that following isolation advice would save lives, experiencing COVID-19 symptoms, being advised to stay in their room, having help from outside and having regular contact by text message from PHE. Factors associated with non-adherence included being angry about the advice to isolate, being unable to get groceries delivered and concerns about losing touch with friends and family. Interviews highlighted that a sense of duty motivated people to adhere to isolation guidance and where people did leave their homes, these decisions were based on rational calculations of the risk of transmission - people would only leave their homes when they thought they were unlikely to come into contact with others. CONCLUSIONS Understanding adherence to isolation and associated reasoning during the early stages of the pandemic is essential to pandemic preparedness for future emerging infectious disease outbreaks. Individuals make complex decisions around adherence by calibrating transmission risks, therefore treating adherence as binary should be avoided.
Collapse
Affiliation(s)
- Charlotte Robin
- Behavioural Science and Insights Unit, UK Health Security Agency, Liverpool, L3 1DS, UK.
| | - Rosy Reynolds
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Helen Lambert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - G James Rubin
- Department of Psychological Medicine, King's College London, London, UK
| | - Louise E Smith
- Department of Psychological Medicine, King's College London, London, UK
| | - Lucy Yardley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Psychology Department, University of Southampton, Southampton, UK
| | - Shenghan Cai
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tingting Zhang
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Piers Mook
- UKHSA, Field Service, Health Protection Operations, London, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Oliver McManus
- UKHSA, Field Service, Health Protection Operations, London, UK
| | - Gemma Lasseter
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Polly Compston
- UKHSA, Field Service, Health Protection Operations, Cambridge, UK
| | - Sarah Denford
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Juan Zhang
- Department of Anthropology and Archaeology, University of Bristol, Bristol, UK
| | - Richard Amlôt
- Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury, UK
| | - Isabel Oliver
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- UKHSA, Field Service, Health Protection Operations, Bristol, UK
| |
Collapse
|
5
|
Woodland L, Smith LE, Brooks SK, Webster RK, Amlôt R, Rubin A, Rubin GJ. Parent-reported child's close contact with non-household family members and their well-being during the COVID-19 pandemic: A cross-sectional survey. PLoS One 2023; 18:e0292344. [PMID: 37856464 PMCID: PMC10586646 DOI: 10.1371/journal.pone.0292344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
In England (UK), at the start of the COVID-19 pandemic the public were required to reduce their physical contacts to slow the spread of COVID-19. We investigated the factors associated with children having: 1) close contact with family members from outside their household ('non-adherent behaviour'); and 2) low well-being (Revised Child Anxiety and Depression Scale). We conducted an online cross-sectional survey, completed at any location of the participant's choice between 8 and 11 June 2020 in parents (n = 2,010) who were aged eighteen years or over and had a school-aged child (4-18 years old). Parents reported that 15% (n = 309) of children had non-adherent contact and that 26% (n = 519) had low well-being. We used a series of binary logistic regressions to investigate associations between outcomes and child and parent characteristics. Children had higher odds of having non-household contact when they had special educational needs [adjusted odds ratio, 2.19 (95% CI, 1.47 to 3.27)], lower well-being [2.65 (95% CI, 2.03 to 3.46)], were vulnerable to COVID-19 [2.17 (95% CI, 1.45 to 3.25)], lived with someone who was over 70 years old [2.56 (95% CI, 1.55 to 4.24)] and their parent had low well-being [1.94 (95% CI, 1.45 to 2.58)]. Children had higher odds of lower well-being when they had special educational needs [4.13 (95% CI, 2.90 to 5.87)], were vulnerable to COVID-19 [3.06 (95% CI, 2.15 to 4.36)], lived with someone else who was vulnerable to COVID-19 [2.08 (95% CI, 1.64 to 2.64)], or lived with someone who was over 70 years old [2.41 (95% CI, 1.51 to 3.83)]. Many children came into contact with non-household family members, mainly for childcare. Factors relating to COVID-19, children's well-being and education were also important. If school closures are needed in future, addressing these issues may help reduce contact.
Collapse
Affiliation(s)
- Lisa Woodland
- Department of Psychological Medicine, King’s College London, London, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, Bristol, United Kingdom
| | - Louise E. Smith
- Department of Psychological Medicine, King’s College London, London, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, Bristol, United Kingdom
| | - Samantha K. Brooks
- Department of Psychological Medicine, King’s College London, London, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, Bristol, United Kingdom
| | - Rebecca K. Webster
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, Bristol, United Kingdom
- Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury, United Kingdom
| | - Antonia Rubin
- Trustee at Weald of Kent Grammar School, Tonbridge, Kent, United Kingdom
| | - G. James Rubin
- Department of Psychological Medicine, King’s College London, London, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, Bristol, United Kingdom
| |
Collapse
|
6
|
Smith LE, Potts HW, Brainard J, May T, Oliver I, Amlôt R, Yardley L, Rubin GJ. Did mpox knowledge, attitudes and beliefs affect intended behaviour in the general population and men who are gay, bisexual and who have sex with men? An online cross-sectional survey in the UK. BMJ Open 2023; 13:e070882. [PMID: 37827743 PMCID: PMC10583036 DOI: 10.1136/bmjopen-2022-070882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/21/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVES To investigate rates of mpox beliefs, knowledge and intended behaviours in the general population and in gay, bisexual or other men who have sex with men (GBMSM), and factors associated with intended behaviours. To test the impact of motivational messages (vs a factual control) on intended behaviours. DESIGN Cross-sectional online survey including a nested randomised controlled trial. SETTING Data collected from 5 September 2022 to 6 October 2022. PARTICIPANTS Participants were aged 18 years or over and lived in the UK (general population). In addition, GBMSM were male, and gay, bisexual or had sex with men. The general population sample was recruited through a market research company. GBMSM were recruited through a market research company, the dating app Grindr and targeted adverts on Meta (Facebook and Instagram). MAIN OUTCOME MEASURES Intention to self-isolate, seek medical help, stop all sexual contact, share details of recent sexual contacts and accept vaccination. RESULTS Sociodemographic characteristics differed by sample. There was no effect of very brief motivational messaging on behavioural intentions. Respondents from Grindr and Meta were more likely to intend to seek help immediately, completely stop sexual behaviour and be vaccinated or intend to be vaccinated, but being less likely to intend to self-isolate (ps<0.001). In the general population sample, intending to carry out protective behaviours was generally associated with being female, older, having less financial hardship, greater worry, higher perceived risk to others and higher perceived susceptibility to and severity of mpox (ps<0.001). There were fewer associations with behaviours in the Grindr sample, possibly due to reduced power. CONCLUSIONS GBMSM were more likely to intend to enact protective behaviours, except for self-isolation. This may reflect targeted public health efforts and engagement with this group. Associations with socioeconomic factors suggest that providing financial support may encourage people to engage with protective behaviours.
Collapse
Affiliation(s)
- Louise E Smith
- Department of Psychological Medicine, King's College London, London, UK
| | - Henry Ww Potts
- Institute of Health Informatics, University College London, London, UK
| | - Julii Brainard
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tom May
- School of Psychological Science, University of Bristol, Bristol, UK
| | | | | | - Lucy Yardley
- School of Psychological Science, University of Bristol, Bristol, UK
| | - G James Rubin
- Department of Psychological Medicine, King's College London, London, UK
| |
Collapse
|
7
|
Littlecott H, Herd C, O'Rourke J, Chaparro LT, Keeling M, James Rubin G, Fearon E. Effectiveness of testing, contact tracing and isolation interventions among the general population on reducing transmission of SARS-CoV-2: a systematic review. Philos Trans A Math Phys Eng Sci 2023; 381:20230131. [PMID: 37611628 PMCID: PMC10446909 DOI: 10.1098/rsta.2023.0131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/23/2023] [Indexed: 08/25/2023]
Abstract
We conducted a systematic literature review of general population testing, contact tracing, case isolation and contact quarantine interventions to assess their effectiveness in reducing SARS-CoV-2 transmission, as implemented in real-world settings. We designed a broad search strategy and aimed to identify peer-reviewed studies of any design provided there was a quantitative measure of effectiveness on a transmission outcome. Studies that assessed the effect of testing or diagnosis on disease outcomes via treatment, but did not assess a transmission outcome, were not included. We focused on interventions implemented among the general population rather than in specific settings; these were from anywhere in the world and published any time after 1 January 2020 until the end of 2022. From 26 720 titles and abstracts, 1181 were reviewed as full text, and 25 met our inclusion criteria. These 25 studies included one randomized control trial (RCT) and the remaining 24 analysed empirical data and made some attempt to control for confounding. Studies included were categorized by the type of intervention: contact tracing (seven studies); specific testing strategies (12 studies); strategies for isolating cases/contacts (four studies); and 'test, trace, isolate' (TTI) as a part of a package of interventions (two studies). None of the 25 studies were rated at low risk of bias and many were rated as serious risk of bias, particularly due to the likely presence of uncontrolled confounding factors, which was a major challenge in assessing the independent effects of TTI in observational studies. These confounding factors are to be expected from observational studies during an on-going pandemic, when the emphasis was on reducing the epidemic burden rather than trial design. Findings from these 25 studies suggested an important public health role for testing followed by isolation, especially where mass and serial testing was used to reduce transmission. Some of the most compelling analyses came from examining fine-grained within-country data on contact tracing; while broader studies which compared behaviour between countries also often found TTI led to reduced transmission and mortality, this was not universal. There was limited evidence for the benefit of isolation of cases/contacts away from the home environment. One study, an RCT, showed that daily testing of contacts could be a viable strategy to replace lengthy quarantine of contacts. Based on the scarcity of robust empirical evidence, we were not able to draw any firm quantitative conclusions about the quantitative impact of TTI interventions in different epidemic contexts. While the majority of studies found that testing, tracing and isolation reduced transmission, evidence for the scale of this impact is only available for specific scenarios and hence is not necessarily generalizable. Our review therefore emphasizes the need to conduct robust experimental studies that help inform the likely quantitative impact of different TTI interventions on transmission and their optimal design. Work is needed to support such studies in the context of future emerging epidemics, along with assessments of the cost-effectiveness of TTI interventions, which was beyond the scope of this review but will be critical to decision-making. This article is part of the theme issue 'The effectiveness of non-pharmaceutical interventions on the COVID-19 pandemic: the evidence'.
Collapse
Affiliation(s)
- Hannah Littlecott
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, Chair of Public Health and Health Services Research, LMU Munich, Germany
| | - Clare Herd
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - John O'Rourke
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Lina Toncon Chaparro
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Matt Keeling
- Zeeman Institute (SBIDER), Mathematics Institute and School of Life Sciences, University of Warwick, Coventry, UK
- JUNIPER consortium, UK
| | - G. James Rubin
- Department of Psychological Medicine, King's College London, London, UK
| | - Elizabeth Fearon
- Institute for Global Health, Faculty of Population Health Sciences, University College London, London, UK
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
8
|
Brainard J, Smith LE, Potts HWW, Rubin GJ. The relationship between age and sex partner counts during the mpox outbreak in the UK, 2022. PLoS One 2023; 18:e0291001. [PMID: 37682827 PMCID: PMC10490899 DOI: 10.1371/journal.pone.0291001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Understanding the dynamics of an infectious disease outbreak linked to sexual activity requires valid expectations of likely counts of unique sex partners during the infectious period. Typically, age is the key demographic trait linked to expected partner count, with many transmission models removing adults from the sexually active pool abruptly at a pre-specified age threshold. Modelling the rate of decline in partner counts with age would benefit from a better description of empirical evidence. METHODS During the 2022 mpox epidemic in the UK, we asked individuals about their partner counts in the preceding three weeks, which is about the same as usual infectious period for persons with active mpox. We used negative binomial regression (all responses) and Weibull regression (non-zero responses) to analyse the relationship between age and partner counts, adjusted for other demographic data (such as education level and occupation), sub-dividing by three types of respondent: men who have sex with men (MSM), men who have sex with women, and women who have sex with men. RESULTS Most respondents had zero or one recent partner, all distributions were skewed. There was a relatively linear declining relationship between age and partner counts for heterosexual partnership groups, but a peak in partner counts and concurrency for MSMs in middle age years (age 35-54), especially for MSM who seemed to be in a highly sexually active subgroup. CONCLUSION Useful data were collected that can be used to describe sex partner counts during the British mpox epidemic and that show distinctive partner count relationships with age, dependent on partnership type.
Collapse
Affiliation(s)
- Julii Brainard
- Norwich Medical School, University of East Anglia Norwich, Norwich, United Kingdom
| | - Louise E. Smith
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Henry W. W. Potts
- Institute of Health Informatics, University College London, London, United Kingdom
| | - G. James Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| |
Collapse
|
9
|
Davies R, Weinman J, Rubin GJ. Observed and self-reported COVID-19 health protection behaviours on a university campus and the impact of a single simple intervention. J Public Health (Oxf) 2023; 45:676-679. [PMID: 36694345 PMCID: PMC10470332 DOI: 10.1093/pubmed/fdac147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 05/31/2022] [Accepted: 10/11/2022] [Indexed: 01/26/2023] Open
Abstract
During the COVID-19 pandemic, most data on adherence to health protective behaviours were collected via a self-report. We quantified the discrepancy between self-report data and discretely observed behaviour in a sample of university staff and students. We assessed the prevalence of cleaning hands, wearing a face-covering and maintaining distance from others. We also tested whether additional signage reminding people that these behaviours were mandatory improved observed adherence. Prevalence estimates based on self-report were higher than those based on observations. Signage was associated with improvements for observed behaviours (all χ2 ≥ 6.0, P < 0.05). We caution that self-reported data can produce misleading adherence rates.
Collapse
Affiliation(s)
- Rachel Davies
- King’s College London, Faculty of Life Sciences and Medicine, UK
| | - John Weinman
- King’s College London, Faculty of Life Sciences and Medicine, UK
| | - G James Rubin
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| |
Collapse
|
10
|
Yardley L, Denford S, Kamal A, May T, Kesten JM, French CE, Weston D, Rubin GJ, Horwood J, Hickman M, Amlôt R, Oliver I. The Agile Co-production and Evaluation framework for developing public health interventions, messaging and guidance. Front Public Health 2023; 11:1094753. [PMID: 37435513 PMCID: PMC10331616 DOI: 10.3389/fpubh.2023.1094753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/05/2023] [Indexed: 07/13/2023] Open
Abstract
A lesson identified from the COVID-19 pandemic is that we need to extend existing best practice for intervention development. In particular, we need to integrate (a) state-of-the-art methods of rapidly coproducing public health interventions and messaging to support all population groups to protect themselves and their communities with (b) methods of rapidly evaluating co-produced interventions to determine which are acceptable and effective. This paper describes the Agile Co-production and Evaluation (ACE) framework, which is intended to provide a focus for investigating new ways of rapidly developing effective interventions and messaging by combining co-production methods with large-scale testing and/or real-world evaluation. We briefly review some of the participatory, qualitative and quantitative methods that could potentially be combined and propose a research agenda to further develop, refine and validate packages of methods in a variety of public health contexts to determine which combinations are feasible, cost-effective and achieve the goal of improving health and reducing health inequalities.
Collapse
Affiliation(s)
- Lucy Yardley
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
- School of Psychology, University of Southampton, Southampton, United Kingdom
- NIHR Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Sarah Denford
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Atiya Kamal
- School of Social Sciences, Birmingham City University, Birmingham, United Kingdom
| | - Tom May
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Jo M. Kesten
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- NIHR Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Clare E French
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Dale Weston
- UK Health Security Agency, London, United Kingdom
| | - G. James Rubin
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom
| | - Jeremy Horwood
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- NIHR Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Matthew Hickman
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- UK Health Security Agency, London, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom
| | - Isabel Oliver
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- UK Health Security Agency, London, United Kingdom
| |
Collapse
|
11
|
Woodland L, Brooks SK, Webster RK, Amlôt R, Rubin GJ. Risk factors for school-based presenteeism in children: a systematic review. BMC Psychol 2023; 11:169. [PMID: 37221597 DOI: 10.1186/s40359-023-01207-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/10/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Children attending school whilst unwell, known as school-based presenteeism, results in negative impacts on education and mental and physical health. We aimed to identify the risk factors for this behaviour. METHOD We conducted a systematic search of five databases (11 July 2022) using words associated with school (e.g., school and childcare) and presenteeism (e.g., presenteeism and sick leave). The studies are synthesised according to the risk factors associated with school-based presenteeism and are grouped into themes by related topics. RESULTS Our review included 18 studies, with quantitative, qualitative, and mixed-method study designs. Children, parents, and school staff reported past incidents and intentions for future presenteeism. We identified five themes from these reports: perceptions about the illness / signs and symptom(s); children's characteristics; children's and parents' motivations and attitudes towards school; organisational factors; and school sickness policy. Increased risk of school-based presenteeism was commonly linked to symptoms that were perceived low in severity and unidentifiable, children with a high school absence record, disbelief in children's illness, unsupportive employers, vague school policies and financial consequences. CONCLUSIONS School-based presenteeism is complex due to the competing interests of the multiple individuals involved, such as children, parents, and school staff. Sickness policies need to include clear and specific guidance about illness and the signs and symptoms of diseases and should be communicated to all relevant individuals to mitigate against discrepancies in how the policy is interpreted. Furthermore, parents and school staff need support, such as financial and childcare, to be able to manage children when they are unwell.
Collapse
Affiliation(s)
- Lisa Woodland
- Department of Psychological Medicine, King's College London, London, UK.
- NIHR Health Protection Research Unit in Emergency Preparedness and Response at King's College London, London, United Kingdom.
| | - Samantha K Brooks
- Department of Psychological Medicine, King's College London, London, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response at King's College London, London, United Kingdom
| | | | - Richard Amlôt
- Behavioural Science and Insights Unit, Health Security Agency, Salisbury, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response at King's College London, London, United Kingdom
| | - G James Rubin
- Department of Psychological Medicine, King's College London, London, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response at King's College London, London, United Kingdom
| |
Collapse
|
12
|
Smith LE, Sim J, Cutts M, Dasch H, Amlôt R, Sevdalis N, Rubin GJ, Sherman SM. Psychosocial factors affecting COVID-19 vaccine uptake in the UK: A prospective cohort study (CoVAccS - Wave 3). Vaccine X 2023; 13:100276. [PMID: 36819214 PMCID: PMC9924044 DOI: 10.1016/j.jvacx.2023.100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Background We investigated factors associated with COVID-19 vaccine uptake, future vaccination intentions, and changes in beliefs and attitudes over time. Methods Prospective cohort study. 1500 participants completed an online survey in January 2021 (T1, start of vaccine rollout in the UK), of whom 1148 (response rate 76.5 %) completed another survey in October 2021 (T2, all UK adults offered two vaccine doses). Binary logistic regression analysis was used to investigate factors associated with subsequent vaccine uptake. Content analysis was used to investigate the main reasons behind future vaccine intentions (T2). Changes in beliefs and attitudes were investigated using analysis of variance. Findings At T2, 90.0 % (95 % CI 88.2-91.7 %) of participants had received two doses of a COVID-19 vaccine, 2.2 % (95 % CI 1.3-3.0 %) had received one dose, and 7.4 % (95 % CI 5.9-8.9 %) had not been vaccinated. Uptake was associated with higher intention to be vaccinated at T1, greater perceived vaccination social norms, necessity of vaccination, and perceived safety of the vaccine. People who had initiated vaccination reported being likely to complete it, while those who had not yet received a vaccine reported being unlikely to be vaccinated in the future. At T2, participants perceived greater susceptibility to, but lower severity of, COVID-19 (p < 0.001) than at T1. Perceived safety and adequacy of vaccine information were higher (p < 0.001). Interpretation Targeting modifiable beliefs about the safety and effectiveness of vaccination may increase uptake.
Collapse
Affiliation(s)
- Louise E. Smith
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK,NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK,Corresponding author at: Department of Psychological Medicine, King’s College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK
| | - Julius Sim
- School of Medicine, Keele University, UK
| | | | - Hannah Dasch
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK,Centre for Implementation Science, King’s College London, UK
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK,Behavioural Science and Insights Unit, UK Health Security Agency, UK
| | - Nick Sevdalis
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK,Centre for Implementation Science, King’s College London, UK
| | - G. James Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK,NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
| | | |
Collapse
|
13
|
Davies R, Martin AF, Smith LE, Mowbray F, Woodland L, Amlôt R, Rubin GJ. The impact of "freedom day" on COVID-19 health protective behaviour in England: An observational study of hand hygiene, face covering use and physical distancing in public spaces pre and post the relaxing of restrictions. JRSM Open 2023; 14:20542704231153563. [PMID: 36895854 PMCID: PMC9989406 DOI: 10.1177/20542704231153563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Objectives To study the prevalence of COVID-19 health protective behaviours before and after rules eased in England on the 19th July 2021. Design Observational study pre (12th-18th July) and post (26th July-1st August) 19th July, and a cross-sectional online survey (26th to 27th July). Setting Observations occurred in supermarkets (n = 10), train stations (n = 10), bus stops (n = 10), a coach station (n = 1) and a London Underground station (n = 1). The survey recruited a nationally representative sample. Participants All adults entering the observed locations during a one-hour period (n = 3819 pre- and n = 2948 post-19th July). In the online survey, 1472 respondents reported having been shopping for groceries/visited a pharmacy and 566 reported having used public transport or having been in a taxi/minicab in the last week. Main outcome measures We observed whether people wore a face covering, maintained distance from others and cleaned their hands. We investigated self-reports of wearing a face covering while in shops or using public transport. Results In most locations observed, the proportion of people wearing face coverings, cleaning the hands and maintaining physical distance declined post 19th July. Pre 19th July, 70.2% (95% CI 68.7 to 71.7%) of people were observed to be wearing a face covering versus 55.8% (54.2 to 57.9%) post 19th July. Equivalent rates for physical distancing were 40.9% (39.0 to 42.8%) versus 29.5% (27.4 to 31.7%), and for hand hygiene were 4.4% (3.8 to 5.1%) versus 3.9% (3.2 to 4.6%). Self-reports of "always" wearing face coverings were broadly similar to observed rates. Conclusions Adherence to protective behaviours was sub-optimal and declined during the relaxation of restrictions, despite appeals to exercise caution. Self-reports of "always" wearing a face covering in specific locations appear valid.
Collapse
Affiliation(s)
- Rachel Davies
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Alex F Martin
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Louise E Smith
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Fiona Mowbray
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Lisa Woodland
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom of Great Britain and Northern Ireland.,Behavioural Science and Insights Unit, UK Health Security Agency, London, United Kingdom of Great Britain and Northern Ireland
| | - G James Rubin
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
14
|
Smith LE, West R, Potts HWW, Amlȏt R, Fear NT, Rubin GJ, Michie S. Knowledge of Self-Isolation Rules in the UK for Those Who Have Symptoms of COVID-19: A Repeated Cross-Sectional Survey Study. Int J Environ Res Public Health 2023; 20:1952. [PMID: 36767316 PMCID: PMC9914733 DOI: 10.3390/ijerph20031952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To investigate knowledge of self-isolation rules and factors associated with knowledge. METHODS Repeated cross-sectional online surveys (n ≈ 2000 UK adults) between 9 November 2020 and 16 February 2022 (78,573 responses from 51,881 participants). We computed a composite measure of knowledge of self-isolation rules and investigated associations between knowledge and survey wave, socio-demographic characteristics (age, gender, UK nation, index of multiple deprivation), trust in government, and participants' belief that they had received enough information about self-isolation. RESULTS In total, 87.9% (95% CI 87.7% to 88.1%, n = 67,288/76,562) of participants knew that if they had symptoms of COVID-19 they should 'self-isolate'. However, only 62.8% (n = 48,058/76,562, 95% CI 62.4% to 63.1%) knew the main rules regarding what that meant. Younger people had less knowledge than older people, and men had less knowledge than women. Knowledge was lower in people living in England versus in Scotland, Wales, and Northern Ireland. The pattern of association between knowledge and trust in government was unclear. Knowledge was lower in people living in a more deprived area and those who did not believe they had enough information about self-isolation. Knowledge was lower in December 2020 to January 2021, compared with before and after this period. CONCLUSIONS Approximately 63% of UK adults between November 2020 and February 2022 appeared to know the main rules regarding self-isolation if symptomatic with COVID-19. Knowledge was lower in younger than older people, men than women, those living in England compared with Scotland, Wales or Northern Ireland, and those living in more deprived areas.
Collapse
Affiliation(s)
- Louise E. Smith
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 9RJ, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London SE5 9RJ, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Henry W. W. Potts
- Institute of Health Informatics, University College London, London NW1 2DA, UK
| | - Richard Amlȏt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London SE5 9RJ, UK
- Behavioural Science and Insights Unit, UK Health Security Agency, London SW1P 3HX, UK
| | - Nicola T. Fear
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 9RJ, UK
- Academic Department of Military Mental Health, King’s Centre for Military Health Research, London SE5 9RJ, UK
| | - G. James Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 9RJ, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London SE5 9RJ, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London WC1E 7HB, UK
| |
Collapse
|
15
|
Smith LE, Sim J, Sherman SM, Amlôt R, Cutts M, Dasch H, Sevdalis N, Rubin GJ. Psychological factors associated with reporting side effects following COVID-19 vaccination: A prospective cohort study (CoVAccS - Wave 3). J Psychosom Res 2023; 164:111104. [PMID: 36495757 PMCID: PMC9708101 DOI: 10.1016/j.jpsychores.2022.111104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To investigate symptom reporting following the first and second COVID-19 vaccine doses, attribution of symptoms to the vaccine, and factors associated with symptom reporting. METHODS Prospective cohort study (T1: 13-15 January 2021, T2: 4-15 October 2021). Participants were aged 18 years or older, living in the UK. Personal, clinical, and psychological factors were investigated at T1. Symptoms were reported at T2. We used logistic regression analyses to investigate associations. RESULTS After the first COVID-19 vaccine dose, 74.1% (95% CI 71.4% to 76.7%, n = 762/1028) of participants reported at least one injection-site symptom, while 65.0% (95% CI 62.0% to 67.9%, n = 669/1029) reported at least one other (non-injection-site) symptom. Symptom reporting was associated with being a woman and younger. After the second dose, 52.9% (95% CI 49.8% to 56.0%, n = 532/1005) of participants reported at least one injection-site symptom and 43.7% (95% CI 40.7% to 46.8%, n = 440/1006) reported at least one other (non-injection-site) symptom. Symptom reporting was associated with having reported symptoms after the first dose, having an illness that put one at higher risk of COVID-19 (non-injection-site symptoms only), and not believing that one had enough information about COVID-19 to make an informed decision about vaccination (injection-site symptoms only). CONCLUSIONS Women and younger people were more likely to report symptoms from vaccination. People who had reported symptoms from previous doses were also more likely to report symptoms subsequently, although symptom reporting following the second vaccine was lower than following the first vaccine. Few psychological factors were associated with symptom reporting.
Collapse
Affiliation(s)
- Louise E. Smith
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, King’s College London, London SE5 9RJ, UK,NIHR Health Protection Research Unit in Emergency Preparedness and Response, Weston Education Centre, King’s College London, London SE5 9RJ, UK,Corresponding author at: Department of Psychological Medicine, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK
| | - Julius Sim
- School of Medicine, David Weatherall Building, University Road, Keele University, Staffordshire, ST5 5BG, UK
| | - Susan M. Sherman
- School of Psychology, Dorothy Hodgkin Building, Keele University, Staffordshire, ST5 5BG, UK
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, Weston Education Centre, King’s College London, London SE5 9RJ, UK,UK Health Security Agency, Chief Scientific Officer’s Group, 17 Smith Square, London, SW1P 3HX, UK
| | - Megan Cutts
- School of Psychology, Dorothy Hodgkin Building, Keele University, Staffordshire, ST5 5BG, UK
| | - Hannah Dasch
- Centre for Implementation Science, NIHR ARC South London, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - Nick Sevdalis
- Centre for Implementation Science, NIHR ARC South London, King’s College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK
| | - G. James Rubin
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, King’s College London, London SE5 9RJ, UK,NIHR Health Protection Research Unit in Emergency Preparedness and Response, Weston Education Centre, King’s College London, London SE5 9RJ, UK
| |
Collapse
|
16
|
Smith LE, Sherman SM, Sim J, Amlôt R, Cutts M, Dasch H, Sevdalis N, Rubin GJ. Parents' intention to vaccinate their child for COVID-19: A mixed-methods study (CoVAccS-wave 3). PLoS One 2022; 17:e0279285. [PMID: 36574421 PMCID: PMC9794060 DOI: 10.1371/journal.pone.0279285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/02/2022] [Indexed: 12/29/2022] Open
Abstract
AIM To investigate UK parents' vaccination intention at a time when COVID-19 vaccination was available to some children. METHODS Data reported are from the second wave of a prospective cohort study. We conducted a mixed-methods study using an online survey of 270 UK parents (conducted 4-15 October 2021). At this time, vaccination was available to 16- and 17-year-olds and had become available to 12- to 15-year-olds two weeks prior. We asked participants whose child had not yet been vaccinated how likely they were to vaccinate their child for COVID-19. Linear regression analyses were used to investigate factors associated with intention (quantitative component). Parents were also asked for their main reasons behind vaccination intention. Open-ended responses were analysed using content analysis (qualitative component). RESULTS Parental vaccination intention was mixed (likely: 39.3%, 95% CI 32.8%, 45.7%; uncertain: 33.9%, 95% CI 27.7%, 40.2%; unlikely: 26.8%, 95% CI 20.9%, 32.6%). Intention was associated with: parental COVID-19 vaccination status; greater perceived necessity and social norms regarding COVID-19 vaccination; greater COVID-19 threat appraisal; and lower vaccine safety and novelty concerns. In those who intended to vaccinate their child, the main reasons for doing so were to protect the child and others. In those who did not intend to vaccinate their child, the main reason was safety concerns. CONCLUSIONS Parent COVID-19 vaccination status and psychological factors explained a large percentage of the variance in vaccination intention for one's child. Further study is needed to see whether parents' intention to vaccinate their child is affected by fluctuating infection rates, more children being vaccinated, and the UK's reliance on vaccination as a strategy to live with COVID-19.
Collapse
Affiliation(s)
- Louise E. Smith
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, England
- * E-mail:
| | - Susan M. Sherman
- Keele University, School of Psychology, Newcastle, United Kingdom
| | - Julius Sim
- Keele University, School of Medicine, Newcastle, United Kingdom
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, England
- UK Health Security Agency, Behavioural Science and Insights Unit, England
| | - Megan Cutts
- Keele University, School of Psychology, Newcastle, United Kingdom
| | - Hannah Dasch
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- King’s College London, Centre for Implementation Science, London, United Kingdom
| | - Nick Sevdalis
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- King’s College London, Centre for Implementation Science, London, United Kingdom
| | - G. James Rubin
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, England
| |
Collapse
|
17
|
Woodland L, Hodson A, Webster RK, Amlôt R, Smith LE, Rubin GJ. A qualitative study about how families coped with managing their well-being, children's physical activity and education during the COVID-19 school closures in England. PLoS One 2022; 17:e0279355. [PMID: 36548349 PMCID: PMC9778504 DOI: 10.1371/journal.pone.0279355] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
In 2020, schools in England closed for six months due to COVID-19, resulting in children being home-schooled. There is limited understanding about the impacts of this on children's mental and physical health and their education. Therefore, we explored how families coped with managing these issues during the school closures. We conducted 30 qualitative interviews with parents of children aged 18 years and under (who would usually be in school) between 16 and 21 April 2020. We identified three themes and eight sub-themes that impacted how families coped whilst schools were closed. We found that family dynamics, circumstances, and resources (Theme 1), changes in entertainment activities and physical movement (Theme 2) and worries about the COVID-19 pandemic (Theme 3) impacted how well families were able to cope. A key barrier to coping was struggles with home-schooling (e.g., lack of resources and support from the school). However, parents being more involved in their children's personal development and education were considered a benefit to home-schooling. Managing the lack of entertainment activities and in-person interactions, and additional health worries about loved ones catching COVID-19 were challenges for families. Parents reported adverse behaviour changes in their children, although overall, they reported they were coping well. However, pre-existing social and educational inequalities are at risk of exacerbation. Families with more resources (e.g., parental supervision, access to green space, technology to facilitate home-schooling and no special educational needs) were better able to cope when schools were closed. On balance, however, families appeared to be able to adapt to the schools being closed. We suggest that policy should focus on supporting families to mitigate the widening health and educational gap between families with more and less resources.
Collapse
Affiliation(s)
- Lisa Woodland
- Department of Psychological Medicine, King’s College London, London, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, England
- * E-mail:
| | - Ava Hodson
- Department of War Studies, King’s College London, London, United Kingdom
| | - Rebecca K. Webster
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, England
- Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury, United Kingdom
| | - Louise E. Smith
- Department of Psychological Medicine, King’s College London, London, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, England
| | - G. James Rubin
- Department of Psychological Medicine, King’s College London, London, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, England
| |
Collapse
|
18
|
Smith LE, Wessely S, Rubin GJ. Public health communicators should stop telling people to rely on their instincts. BMJ 2022; 379:o3008. [PMID: 36517038 DOI: 10.1136/bmj.o3008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Louise E Smith
- NIHR Health Protection Research Unit in Emergency Preparedness and Response at King's College London
| | - Simon Wessely
- NIHR Health Protection Research Unit in Emergency Preparedness and Response at King's College London
| | - G James Rubin
- NIHR Health Protection Research Unit in Emergency Preparedness and Response at King's College London
| |
Collapse
|
19
|
Lasseter G, Compston P, Robin C, Lambert H, Hickman M, Denford S, Reynolds R, Zhang J, Cai S, Zhang T, Smith LE, Rubin GJ, Yardley L, Amlôt R, Oliver I. Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation. BMC Public Health 2022; 22:2145. [PMID: 36418978 PMCID: PMC9685010 DOI: 10.1186/s12889-022-14368-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The national shielding programme was introduced by UK Government at the beginning of the COVID-19 pandemic, with individuals identified as clinically extremely vulnerable (CEV) offered advice and support to stay at home and avoid all non-essential contact. This study aimed to explore the impact and responses of "shielding" on the health and wellbeing of CEV individuals in Southwest England during the first COVID-19 lockdown. METHODS A two-stage mixed methods study, including a structured survey (7 August-23 October 2020) and semi-structured telephone interviews (26 August-30 September 2020) with a sample of individuals who had been identified as CEV and advised to "shield" by Bristol, North Somerset & South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG). RESULTS The survey was completed by 203 people (57% female, 54% > 69 years, 94% White British, 64% retired) in Southwest England identified as CEV by BNSSG CCG. Thirteen survey respondents participated in follow-up interviews (53% female, 40% > 69 years, 100% White British, 61% retired). Receipt of 'official' communication from NHS England or General Practitioner (GP) was considered by participants as the legitimate start of shielding. 80% of survey responders felt they received all relevant advice needed to shield, yet interviewees criticised the timing of advice and often sought supplementary information. Shielding behaviours were nuanced, adapted to suit personal circumstances, and waned over time. Few interviewees received community support, although food boxes and informal social support were obtained by some. Worrying about COVID-19 was common for survey responders (90%). Since shielding had begun, physical and mental health reportedly worsened for 35% and 42% of survey responders respectively. 21% of survey responders scored ≥ 10 on the PHQ-9 questionnaire indicating possible depression and 15% scored ≥ 10 on the GAD-7 questionnaire indicating possible anxiety. CONCLUSIONS This research highlights the difficulties in providing generic messaging that is applicable and appropriate given the diversity of individuals identified as CEV and the importance of sharing tailored and timely advice to inform shielding decisions. Providing messages that reinforce self-determined action and assistance from support services could reduce the negative impact of shielding on mental health and feelings of social isolation.
Collapse
Affiliation(s)
- Gemma Lasseter
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK
| | - Polly Compston
- grid.515304.60000 0005 0421 4601Field Epidemiology Service, UK Health Security Agency, Cambridge, UK
| | - Charlotte Robin
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.515304.60000 0005 0421 4601Field Epidemiology, Field Service, National Infection Service, UK Health Security Agency, Liverpool, UK ,grid.10025.360000 0004 1936 8470NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK ,grid.10025.360000 0004 1936 8470NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - Helen Lambert
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK
| | - Matthew Hickman
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK
| | - Sarah Denford
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.5337.20000 0004 1936 7603School of Psychological Science, University of Bristol, Bristol, UK
| | - Rosy Reynolds
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK
| | - Juan Zhang
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shenghan Cai
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tingting Zhang
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Louise E. Smith
- grid.13097.3c0000 0001 2322 6764NIHR Health Protection Research Unit in Emergency Preparedness and Response, King’s College London, London, UK ,grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, King’s College London, London, UK
| | - G James Rubin
- grid.13097.3c0000 0001 2322 6764NIHR Health Protection Research Unit in Emergency Preparedness and Response, King’s College London, London, UK ,grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, King’s College London, London, UK
| | - Lucy Yardley
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.5337.20000 0004 1936 7603School of Psychological Science, University of Bristol, Bristol, UK ,grid.5491.90000 0004 1936 9297Psychology Department, University of Southampton, Southampton, UK
| | - Richard Amlôt
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.515304.60000 0005 0421 4601Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury, UK
| | - Isabel Oliver
- grid.5337.20000 0004 1936 7603NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, BS8 2BN UK ,grid.515304.60000 0005 0421 4601Field Epidemiology Service, UK Health Security Agency, Cambridge, UK
| |
Collapse
|
20
|
Smith LE, Amlȏt R, Fear NT, Michie S, Rubin GJ, Potts HW. Psychological wellbeing in the English population during the COVID-19 pandemic: A series of cross-sectional surveys. J Psychiatr Res 2022; 153:254-259. [PMID: 35843066 PMCID: PMC9239838 DOI: 10.1016/j.jpsychires.2022.06.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 05/13/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
Psychological distress has been elevated during the COVID-19 pandemic. However, few studies published to date have investigated distress after the first wave of infections (Spring - Summer 2020). We investigated distress and wellbeing between April 2020 and April 2022 in England through a series of cross-sectional online surveys. People aged 16 years or over living in the UK were eligible for the surveys; for this study we selected only those living in England due to differences in restrictions between UK nations. Distress was measured using the PHQ4 (n = 60,921 responses), while wellbeing was measured using the Short Warwick-Edinburgh Mental Wellbeing Scale (n = 61,152 responses). Throughout, approximately 50%-60% of women and 40%-50% of men reported distress, higher than the 25%-30% of women, and 20%-25% of men reported in normative data. Wellbeing was also worse than population norms, with women reporting lower wellbeing than men. Rates of distress in the English population have been consistently high throughout the pandemic. Patterns of distress have broadly mirrored the pattern of restrictions and case numbers, but there are notable exceptions which indicate that other factors may play a part in population mental health.
Collapse
Affiliation(s)
- Louise E. Smith
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom,NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom,Corresponding author. Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, United Kingdom
| | - Richard Amlȏt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom,UK Health Security Agency, Behavioural Science and Insights Unit, United Kingdom
| | - Nicola T. Fear
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom,King's Centre for Military Health Research and Academic Department of Military Mental Health, United Kingdom
| | - Susan Michie
- University College London, Centre for Behaviour Change, United Kingdom
| | - G James Rubin
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, United Kingdom,NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom
| | - Henry W.W. Potts
- University College London, Institute of Health Informatics, United Kingdom
| |
Collapse
|
21
|
Smith LE, Potts HW, Amlôt R, Fear NT, Michie S, Rubin GJ. How has the emergence of the Omicron SARS-CoV-2 variant of concern influenced worry, perceived risk and behaviour in the UK? A series of cross-sectional surveys. BMJ Open 2022; 12:e061203. [PMID: 36038165 PMCID: PMC9437738 DOI: 10.1136/bmjopen-2022-061203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate changes in beliefs and behaviours following news of the Omicron variant and changes to guidance understanding of Omicron-related guidance, and factors associated with engaging with protective behaviours. DESIGN Series of cross-sectional surveys (1 November to 16 December 2021, five waves of data collection). SETTING Online. PARTICIPANTS People living in England, aged 16 years or over (n=1622-1902 per wave). PRIMARY AND SECONDARY OUTCOME MEASURES Levels of worry and perceived risk, and engagement with key behaviours (out-of-home activities, risky social mixing, wearing a face covering and testing uptake). RESULTS Degree of worry and perceived risk of COVID-19 (to oneself and people in the UK) fluctuated over time, increasing slightly around the time of the announcement about Omicron (p<0.001). Understanding of rules in England was varied, ranging between 10.3% and 91.9%, with people overestimating the stringency of the new rules. Rates of wearing a face covering and testing increased over time (p<0.001). Meeting up with people from another household decreased around the time of the announcement of Omicron (29 November to 1 December), but then returned to previous levels (p=0.002). Associations with protective behaviours were investigated using regression analyses. There was no evidence for significant associations between out-of-home activity and worry or perceived risk (COVID-19 generally or Omicron-specific, p≥0.004; Bonferroni adjustment p<0.002 applied). Engaging in highest risk social mixing and always wearing a face covering were associated with worry and perceived risk about COVID-19 (p≤0.001). Always wearing a face covering in shops was associated with having heard more about Omicron (p<0.001). CONCLUSIONS Almost 2 years into the COVID-19 outbreak, the emergence of a novel variant of concern only slightly influenced worry and perceived risk. The main protective behaviour (wearing a face covering) promoted by new guidance showed significant re-uptake, but other protective behaviours showed little or no change.
Collapse
Affiliation(s)
- Louise E Smith
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
| | - Henry Ww Potts
- Institute of Health Informatics, University College London, London, UK
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
- Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury, UK
| | - Nicola T Fear
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - G James Rubin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
| |
Collapse
|
22
|
Love NK, Ready DR, Turner C, Yardley L, Rubin GJ, Hopkins S, Oliver I. The acceptability of testing contacts of confirmed COVID-19 cases using serial, self-administered lateral flow devices as an alternative to self-isolation. J Med Microbiol 2022; 71. [PMID: 35947525 DOI: 10.1099/jmm.0.001567] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction. Evidence suggests that although people modify their behaviours, full adherence to self-isolation guidance in England may be suboptimal, which may have a detrimental impact on COVID-19 transmission rates.Hypothesis. Testing asymptomatic contacts of confirmed COVID-19 cases for the presence of SARS-CoV-2 could reduce onward transmission by improving case ascertainment and lessen the impact of self-isolation on un-infected individuals.Aim. This study investigated the feasibility and acceptability of implementing a 'test to enable approach' as part of England's tracing strategy.Methodology. Contacts of confirmed COVID-19 cases were offered serial testing as an alternative to self-isolation using daily self-performed lateral flow device (LFD) tests for the first 7 days post-exposure. Asymptomatic participants with a negative LFD result were given 24 h of freedom from self-isolation between each test. A self-collected confirmatory PCR test was performed on testing positive or at the end of the LFD testing period.Results. Of 1760 contacts, 882 consented to daily testing, of whom 812 individuals were within 48 h of exposure and were sent LFD testing packs. Of those who declined to participate, 39.1% stated they had already accessed PCR testing. Of the 812 who were sent LFD packs, 570 (70.2%) reported one or more LFD results; 102 (17.9%) tested positive. Concordance between reported LFD result and a supplied LFD image was 97.1%. In total, 82.8% of PCR-positive samples and 99.6% of PCR-negative samples were correctly detected by LFD. The proportion of secondary cases from contacts of those who participated in the study and tested positive (6.3%; 95% CI: 3.4-11.1%) was comparable to a comparator group who self-isolated (7.6%; 95% CI: 7.3-7.8%).Conclusion. This study shows a high acceptability, compliance and positivity rates when using self-administered LFDs among contacts of confirmed COVID-19 cases. Offering routine testing as a structured part of the contact tracing process is likely to be an effective method of case ascertainment.
Collapse
Affiliation(s)
| | - Derren R Ready
- UK Health Security Agency, England, UK.,Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | | | - Lucy Yardley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,School of Psychological Science, University of Bristol, Bristol, UK.,Department of Psychology, University of Southampton, Southampton, UK
| | - G James Rubin
- Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
| | | | - Isabel Oliver
- UK Health Security Agency, England, UK.,Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| |
Collapse
|
23
|
Davies R, Mowbray F, Martin AF, Smith LE, Rubin GJ. A systematic review of observational methods used to quantify personal protective behaviours among members of the public during the COVID-19 pandemic, and the concordance between observational and self-report measures in infectious disease health protection. BMC Public Health 2022; 22:1436. [PMID: 35902818 PMCID: PMC9330943 DOI: 10.1186/s12889-022-13819-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/11/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To assess the quantity and quality of studies using an observational measure of behaviour during the COVID-19 pandemic, and to narratively describe the association between self-report and observational data for behaviours relevant to controlling an infectious disease outbreak. DESIGN Systematic review and narrative synthesis of observational studies. DATA SOURCES We searched Medline, Embase, PsychInfo, Publons, Scopus and the UK Health Security Agency behavioural science LitRep database from inception to 17th September 2021 for relevant studies. STUDY SELECTION We included studies which collected observational data of at least one of three health protective behaviours (hand hygiene, face covering use and maintaining physical distance from others ('social distancing') during the COVID-19 pandemic. Studies where observational data were compared to self-report data in relation to any infectious disease were also included. DATA EXTRACTION AND SYNTHESIS We evaluated the quality of studies using the NIH quality assessment scale for observational studies, extracted data on sample size, setting and adherence to health protective behaviours, and synthesized results narratively. RESULTS Of 27,279 published papers on COVID-19 relevant health protective behaviours that included one or more terms relating to hand hygiene, face covering and social distancing, we identified 48 studies that included an objective observational measure. Of these, 35 assessed face covering use, 17 assessed hand hygiene behaviour and seven assessed physical distancing. The general quality of these studies was good. When expanding the search to all infectious diseases, we included 21 studies that compared observational versus self-report data. These almost exclusively studied hand hygiene. The difference in outcomes was striking, with self-report over-estimating observed adherence by up to a factor of five in some settings. In only four papers did self-report match observational data in any domains. CONCLUSIONS Despite their importance in controlling the pandemic, we found remarkably few studies assessing protective behaviours by observation, rather than self-report, though these studies tended to be of reasonably good quality. Observed adherence tends to be substantially lower than estimates obtained via self-report. Accurate assessment of levels of personal protective behaviour, and evaluation of interventions to increase this, would benefit from the use of observational methods.
Collapse
Affiliation(s)
- Rachel Davies
- National Institute of Health Research Health Protection Research Unit in Emergency Preparedness and Response at King's College London, in partnership with the UK Health Security Agency, London, UK.
| | - Fiona Mowbray
- National Institute of Health Research Health Protection Research Unit in Emergency Preparedness and Response at King's College London, in partnership with the UK Health Security Agency, London, UK
| | - Alex F Martin
- National Institute of Health Research Health Protection Research Unit in Emergency Preparedness and Response at King's College London, in partnership with the UK Health Security Agency, London, UK
| | - Louise E Smith
- National Institute of Health Research Health Protection Research Unit in Emergency Preparedness and Response at King's College London, in partnership with the UK Health Security Agency, London, UK
| | - G James Rubin
- National Institute of Health Research Health Protection Research Unit in Emergency Preparedness and Response at King's College London, in partnership with the UK Health Security Agency, London, UK
| |
Collapse
|
24
|
Denford S, Martin AF, Towler L, Mowbray F, Essery R, Bloomer R, Ready D, Love N, Amlôt R, Oliver I, Rubin GJ, Yardley L. A qualitative process analysis of daily contact testing as an alternative to self-isolation following close contact with a confirmed carrier of SARS-CoV-2. BMC Public Health 2022; 22:1373. [PMID: 35850742 PMCID: PMC9294818 DOI: 10.1186/s12889-022-13800-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In July 2021, a randomised controlled trial was conducted to compare the effect on SARS-CoV-2 transmission of seven days of Daily Contact Testing (DCT) using Lateral Flow Test (LFT) and two Polymerase Chain Reaction (PCR) tests as an alternative to 10 days of standard self-isolation with one PCR, following close contact with a SARS-CoV-2 carrier. In this qualitative study, we used a nested process evaluation to aid interpretation of the trial and provide insight into factors influencing use of tests, understanding of test results, and how tests were used to inform behavioural decisions. METHODS Interviews were conducted with 60 participants (42 randomised to DCT and 18 randomised to self-isolation) who had been in close contact with a confirmed SARS-CoV-2 carrier and had consented to take part in the trial. RESULTS Data were organised into three overarching themes: (1) assessing the risks and benefits of DCT (2) use of testing during the study period and (3) future use of testing. Attitudes toward DCT as an alternative to self-isolation and behaviour during the testing period appeared to be informed by an assessment of the associated risks and benefits. Participants reported how important it was for them to avoid isolation, how necessary self-isolation was considered to be, and the ability of LFTs to detect infection. Behaviour during the testing period was modified to reduce risks and harms as much as possible. Testing was considered a potential compromise, reducing both risk of transmission and the negative impact of self-isolation, and was regarded as a way to return to normal. CONCLUSION Participants in this study viewed DCT as a sensible, feasible, and welcome means of avoiding unnecessary self-isolation. Although negative LFTs provided reassurance, most people still restricted their activity as recommended. DCT was also highly valued by those in vulnerable households as a means of providing reassurance of the absence of infection and as an important means of detecting infection and prompting self-isolation when necessary.
Collapse
Affiliation(s)
- Sarah Denford
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in Collaboration With UK Health Security Agency, Bristol, UK. .,Population Health Sciences, Bristol Medical School, University of Bristol, Priory Road Complex, BS8 1TU, Bristol, UK. .,School of Psychological Science, University of Bristol, Bristol, UK.
| | - Alex F Martin
- Health Protection Research Unit in Emergency Preparedness and Response at King's College London in Collaboration With UK Health Security Agency, London, UK
| | - Lauren Towler
- School of Psychological Science, University of Bristol, Bristol, UK.,School of Psychology, University of Southampton, Southampton, UK
| | - Fiona Mowbray
- Health Protection Research Unit in Emergency Preparedness and Response at King's College London in Collaboration With UK Health Security Agency, London, UK
| | - Rosie Essery
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in Collaboration With UK Health Security Agency, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Priory Road Complex, BS8 1TU, Bristol, UK.,School of Psychological Science, University of Bristol, Bristol, UK.,School of Psychology, University of Southampton, Southampton, UK
| | - Rachael Bloomer
- Population Health Sciences, Bristol Medical School, University of Bristol, Priory Road Complex, BS8 1TU, Bristol, UK
| | - Derren Ready
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in Collaboration With UK Health Security Agency, Bristol, UK.,UK Health Security Agency, London, England, UK
| | - Nicola Love
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in Collaboration With UK Health Security Agency, Bristol, UK.,UK Health Security Agency, London, England, UK
| | - Richard Amlôt
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in Collaboration With UK Health Security Agency, Bristol, UK.,Health Protection Research Unit in Emergency Preparedness and Response at King's College London in Collaboration With UK Health Security Agency, London, UK.,UK Health Security Agency, London, England, UK
| | - Isabel Oliver
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in Collaboration With UK Health Security Agency, Bristol, UK.,UK Health Security Agency, London, England, UK
| | - G James Rubin
- Health Protection Research Unit in Emergency Preparedness and Response at King's College London in Collaboration With UK Health Security Agency, London, UK
| | - Lucy Yardley
- Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in Collaboration With UK Health Security Agency, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Priory Road Complex, BS8 1TU, Bristol, UK.,School of Psychological Science, University of Bristol, Bristol, UK.,School of Psychology, University of Southampton, Southampton, UK
| |
Collapse
|
25
|
Smith LE, Potts HWW, Amlȏt R, Fear NT, Michie S, Rubin GJ. Patterns of social mixing in England changed in line with restrictions during the COVID-19 pandemic (September 2020 to April 2022). Sci Rep 2022; 12:10436. [PMID: 35729196 PMCID: PMC9212204 DOI: 10.1038/s41598-022-14431-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/07/2022] [Indexed: 11/20/2022] Open
Abstract
Social mixing contributes to the transmission of SARS-CoV-2. We developed a composite measure for risky social mixing, investigating changes during the pandemic and factors associated with risky mixing. Forty-five waves of online cross-sectional surveys were used (n = 78,917 responses; 14 September 2020 to 13 April 2022). We investigated socio-demographic, contextual and psychological factors associated with engaging in highest risk social mixing in England at seven timepoints. Patterns of social mixing varied over time, broadly in line with changes in restrictions. Engaging in highest risk social mixing was associated with being younger, less worried about COVID-19, perceiving a lower risk of COVID-19, perceiving COVID-19 to be a less severe illness, thinking the risks of COVID-19 were being exaggerated, not agreeing that one’s personal behaviour had an impact on how COVID-19 spreads, and not agreeing that information from the UK Government about COVID-19 can be trusted. Our composite measure for risky social mixing varied in line with restrictions in place at the time of data collection, providing some validation of the measure. While messages targeting psychological factors may reduce higher risk social mixing, achieving a large change in risky social mixing in a short space of time may necessitate a reimposition of restrictions.
Collapse
Affiliation(s)
- Louise E Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,NIHR Health Protection Research Unit in Emergency Preparedness and Response, Weston Education Centre, King's College London, Cutcombe Road, London, SE5 9RJ, UK. .,Department of Psychological Medicine, Weston Education Centre, King's College London, Cutcombe Road, London, SE5 9RJ, UK.
| | - Henry W W Potts
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Richard Amlȏt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, Weston Education Centre, King's College London, Cutcombe Road, London, SE5 9RJ, UK.,Behavioural Science and Insights Unit, UK Health Security Agency, Porton Down, Wiltshire, Salisbury, SP4 0JG, UK
| | - Nicola T Fear
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK.,Department of Psychological Medicine, Weston Education Centre, King's College London, Cutcombe Road, London, SE5 9RJ, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - G James Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,NIHR Health Protection Research Unit in Emergency Preparedness and Response, Weston Education Centre, King's College London, Cutcombe Road, London, SE5 9RJ, UK.,Department of Psychological Medicine, Weston Education Centre, King's College London, Cutcombe Road, London, SE5 9RJ, UK
| |
Collapse
|
26
|
Smith LE, Potts HWW, Amlȏt R, Fear NT, Michie S, Rubin GJ. Corrigendum to 'Tiered restrictions for COVID-19 in England: Knowledge, motivation and self-reported behaviour' [Public Health 204 (2022) 33-39]. Public Health 2022; 209:1-3. [PMID: 35738175 PMCID: PMC9212342 DOI: 10.1016/j.puhe.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L E Smith
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK.
| | - H W W Potts
- University College London, Institute of Health Informatics, UK
| | - R Amlȏt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK; UK Health Security Agency, Behavioural Science and Insights Unit, UK
| | - N T Fear
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; King's Centre for Military Health Research and Academic Department of Military Mental Health, UK
| | - S Michie
- University College London, Centre for Behaviour Change, UK
| | - G J Rubin
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
| |
Collapse
|
27
|
Smith LE, Potts HWW, Amlȏt R, Fear NT, Michie S, Rubin GJ. Correction: Engagement with protective behaviours in the UK during the COVID-19 pandemic: a series of cross-sectional surveys (the COVID-19 rapid survey of adherence to interventions and responses [CORSAIR] study). BMC Public Health 2022; 22:1163. [PMID: 35689193 PMCID: PMC9185705 DOI: 10.1186/s12889-022-13472-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Louise E Smith
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, England. .,NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, England.
| | - Henry W W Potts
- University College London, Institute of Health Informatics, 222 Euston Road, London, NW1 2DA, England
| | - Richard Amlȏt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, England.,Emergency Response Department Science and Technology, UK Health Security Agency, Behavioural Science Team, Salisbury, Wiltshire, SP4 0JG, England
| | - Nicola T Fear
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, England.,King's Centre for Military Health Research and the Academic Department of Military Mental Health, King's College London, London, England
| | - Susan Michie
- Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, England
| | - G James Rubin
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, England.,NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, England
| |
Collapse
|
28
|
Rubin GJ, Wessely S, Greenberg N, Brooks SK. Quality appraisal of evidence generated during a crisis: in defence of 'timeliness' and 'clarity' as criteria. BMJ Evid Based Med 2022; 27:189. [PMID: 34168011 DOI: 10.1136/bmjebm-2021-111760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/04/2022]
Affiliation(s)
- G James Rubin
- Department of Psychological Medicine, King's College London, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, King's College London, London, UK
| | - Neil Greenberg
- Department of Psychological Medicine, King's College London, London, UK
| | - Samantha K Brooks
- Department of Psychological Medicine, King's College London, London, UK
| |
Collapse
|
29
|
Rubin GJ, Smith LE, Amlot R, Fear NT, Potts H, Michie S. Do people with symptoms of an infectious illness follow advice to stay at home? Evidence from a series of cross-sectional surveys about presenteeism in the UK. BMJ Open 2022; 12:e060511. [PMID: 35636788 PMCID: PMC9152621 DOI: 10.1136/bmjopen-2021-060511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To assess the percentage of people in the UK with cough, fever or loss of taste or smell who have not had a positive COVID-19 test result who had been to work, to shops, socialised or provided care to a vulnerable person in the 10 days after developing symptoms. To investigate whether these rates differed according to the type of symptom, what the participant thought the cause of their symptoms was and whether they had taken a COVID-19 test. DESIGN Four online cross-sectional surveys using non-probability quota sampling method (n=8547). SETTING Data were collected across the UK from 20 September to 3 November 2021, via a market research company. PARTICIPANTS Aged over 16 years living in the UK. PRIMARY OUTCOME MEASURES Out-of-home activity. RESULTS 498 participants reported one or more symptoms and had not had a positive COVID-19 test result. Within that group, about half of employed participants had attended work while symptomatic (51.2%-56.3% depending on the symptom, 95% CIs 42.2% to 65.6%). Rates of other contact behaviours ranged from 31.4% (caring for a vulnerable person after developing a cough: 95% CI 24.3% to 38.4%) to 61.5% (shopping for groceries or pharmacy after developing a cough: 95% CI 54.1% to 68.9%). There were no differences according to type of symptom experienced or what the participant felt might be the cause. People who had taken a COVID-19 test were less likely to go out shopping for non-essentials than people who had not taken a test. CONCLUSION Many people in the UK with symptoms of an infectious disease were not following government advice to stay at home if they believed they had an infectious illness. Reducing these rates may require a shift in our national attitude to the acceptability of people attending work with infectious illnesses.
Collapse
Affiliation(s)
- G James Rubin
- Department of Psychological Medicine, King's College London, London, UK
| | - Louise E Smith
- Department of Psychological Medicine, King's College London, London, UK
| | | | | | - Henry Potts
- Institute of Health Informatics, University College London, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| |
Collapse
|
30
|
Gnanapragasam SN, Hodson A, Smith LE, Greenberg N, Rubin GJ, Wessely S. COVID-19 survey burden for health care workers: literature review and audit. Public Health 2022; 206:94-101. [PMID: 35489796 PMCID: PMC8148427 DOI: 10.1016/j.puhe.2021.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/27/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022]
Abstract
Objectives Concerns have been raised about the quantity and quality of research conducted during the COVID-19 pandemic, particularly related to the mental health and wellbeing of health care workers (HCWs). For understanding the volume, source, methodological rigour and degree of overlap in COVID-19, studies were conducted among HCWs in the United Kingdom (UK). Study design Mixed methods approach, literature review and audit. Methods First, a literature review of published research studies and second, an audit of studies HCWs have been invited to complete. For the literature review, we searched Medline, PsycINFO and Nexis, webpages of three medical organisations (Royal Society of Medicine, Royal College of Nursing and British Medical Association), and the YouGov website. For the audit, a non-random purposive sample of six HCWs from different London NHS Trusts reviewed email, WhatsApp and SMS messages they received for study invitations. Results The literature review identified 27 studies; the audit identified 70 study invitations. Studies identified by the literature review were largely of poor methodological rigour: only eight studies (30%) provided response rate, one study (4%) reported having ethical approval, and one study (4%) reported funding details. There was substantial overlap in the topics measured. In the audit, volunteers received a median of 12 invitations. The largest number of study invitations were for national surveys (n = 23), followed by local surveys (n = 16) and research surveys (n = 8). Conclusion HCWs have been asked to complete numerous surveys that frequently have methodological shortcomings and overlapping aims. Many studies do not follow scientific good-practice and generate questionable, non-generalisable results.
Collapse
Affiliation(s)
| | - A Hodson
- Department of War Studies, King's College London, London, UK
| | - L E Smith
- Department of Psychological Medicine, King's College London, London, UK
| | - N Greenberg
- Department of Psychological Medicine, King's College London, London, UK
| | - G J Rubin
- Department of Psychological Medicine, King's College London, London, UK
| | - S Wessely
- Department of Psychological Medicine, King's College London, London, UK
| |
Collapse
|
31
|
Smith LE, Potts HWW, Amlȏt R, Fear NT, Michie S, Rubin GJ. Engagement with protective behaviours in the UK during the COVID-19 pandemic: a series of cross-sectional surveys (the COVID-19 rapid survey of adherence to interventions and responses [CORSAIR] study). BMC Public Health 2022; 22:475. [PMID: 35272652 PMCID: PMC8907902 DOI: 10.1186/s12889-022-12777-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background Behaviour is key to suppressing the COVID-19 pandemic. Maintaining behaviour change can be difficult. We investigated engagement with hand cleaning, reducing the number of outings, and wearing a face covering over the course of the pandemic. Methods We used a series of 64 cross-sectional surveys between 10 February 2020 and 20 January 2022 (n ≈ 2000 per wave). Surveys investigated uptake of hand cleaning behaviours, out of home activity (England only, n ≈ 1700 per wave) and wearing a face covering (England only, restricted to those who reported going out shopping in the last week, n ≈ 1400 per wave). Results Reported hand cleaning has been high throughout the pandemic period (85 to 90% of participants consistently reporting washing their hands thoroughly and regularly with soap and water frequently or very frequently). Out of home activity has mirrored the easing and re-introduction of restrictive measures. Total number of outings were higher in the second national lockdown than in the first and third lockdowns. Wearing a face covering increased steadily between April to August 2020, plateauing until the end of measurement in May 2021, with approximately 80% of those who had been out shopping in the previous week reporting wearing a face covering frequently or very frequently. Conclusions Engagement with protective behaviours increased at the start of the pandemic and has remained high since. The greatest variations in behaviour reflected changes to Government rules. Despite the duration of restrictions, people have continued to adopt personal protective behaviours that were intended to prevent the spread of COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12777-x.
Collapse
Affiliation(s)
- Louise E Smith
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, England. .,NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, England.
| | - Henry W W Potts
- University College London, Institute of Health Informatics, 222 Euston Road, London, NW1 2DA, England
| | - Richard Amlȏt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, England.,Emergency Response Department Science and Technology, UK Health Security Agency, Behavioural Science Team, Salisbury, Wiltshire, SP4 0JG, England
| | - Nicola T Fear
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, England.,King's Centre for Military Health Research and the Academic Department of Military Mental Health, King's College London, London, England
| | - Susan Michie
- Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, England
| | - G James Rubin
- Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, England.,NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, England
| |
Collapse
|
32
|
Gimma A, Munday JD, Wong KLM, Coletti P, van Zandvoort K, Prem K, Klepac P, Rubin GJ, Funk S, Edmunds WJ, Jarvis CI. Changes in social contacts in England during the COVID-19 pandemic between March 2020 and March 2021 as measured by the CoMix survey: A repeated cross-sectional study. PLoS Med 2022; 19:e1003907. [PMID: 35231023 PMCID: PMC8887739 DOI: 10.1371/journal.pmed.1003907] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 01/06/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND During the Coronavirus Disease 2019 (COVID-19) pandemic, the United Kingdom government imposed public health policies in England to reduce social contacts in hopes of curbing virus transmission. We conducted a repeated cross-sectional study to measure contact patterns weekly from March 2020 to March 2021 to estimate the impact of these policies, covering 3 national lockdowns interspersed by periods of less restrictive policies. METHODS AND FINDINGS The repeated cross-sectional survey data were collected using online surveys of representative samples of the UK population by age and gender. Survey participants were recruited by the online market research company Ipsos MORI through internet-based banner and social media ads and email campaigns. The participant data used for this analysis are restricted to those who reported living in England. We calculated the mean daily contacts reported using a (clustered) bootstrap and fitted a censored negative binomial model to estimate age-stratified contact matrices and estimate proportional changes to the basic reproduction number under controlled conditions using the change in contacts as a scaling factor. To put the findings in perspective, we discuss contact rates recorded throughout the year in terms of previously recorded rates from the POLYMOD study social contact study. The survey recorded 101,350 observations from 19,914 participants who reported 466,710 contacts over 53 weeks. We observed changes in social contact patterns in England over time and by participants' age, personal risk factors, and perception of risk. The mean reported contacts for adults 18 to 59 years old ranged between 2.39 (95% confidence interval [CI] 2.20 to 2.60) contacts and 4.93 (95% CI 4.65 to 5.19) contacts during the study period. The mean contacts for school-age children (5 to 17 years old) ranged from 3.07 (95% CI 2.89 to 3.27) to 15.11 (95% CI 13.87 to 16.41). This demonstrates a sustained decrease in social contacts compared to a mean of 11.08 (95% CI 10.54 to 11.57) contacts per participant in all age groups combined as measured by the POLYMOD social contact study in 2005 to 2006. Contacts measured during periods of lockdowns were lower than in periods of eased social restrictions. The use of face coverings outside the home has remained high since the government mandated use in some settings in July 2020. The main limitations of this analysis are the potential for selection bias, as participants are recruited through internet-based campaigns, and recall bias, in which participants may under- or overreport the number of contacts they have made. CONCLUSIONS In this study, we observed that recorded contacts reduced dramatically compared to prepandemic levels (as measured in the POLYMOD study), with changes in reported contacts correlated with government interventions throughout the pandemic. Despite easing of restrictions in the summer of 2020, the mean number of reported contacts only returned to about half of that observed prepandemic at its highest recorded level. The CoMix survey provides a unique repeated cross-sectional data set for a full year in England, from the first day of the first lockdown, for use in statistical analyses and mathematical modelling of COVID-19 and other diseases.
Collapse
Affiliation(s)
- Amy Gimma
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - James D. Munday
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kerry L. M. Wong
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Pietro Coletti
- UHasselt, Data Science Institute and I-BioStat, Hasselt, Belgium
| | - Kevin van Zandvoort
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kiesha Prem
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Petra Klepac
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - G. James Rubin
- Department of Psychological Medicine, King’s College London, Denmark Hill, London, United Kingdom
| | - Sebastian Funk
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - W. John Edmunds
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Christopher I. Jarvis
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
33
|
Woodland L, Mowbray F, Smith LE, Webster RK, Amlôt R, Rubin GJ. What influences whether parents recognise COVID-19 symptoms, request a test and self-isolate: A qualitative study. PLoS One 2022; 17:e0263537. [PMID: 35196349 PMCID: PMC8865653 DOI: 10.1371/journal.pone.0263537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Using test, trace and isolate systems can help reduce the spread of COVID-19. Parents have the additional responsibility of using these systems for themselves and acting on behalf of their children to help control COVID-19. We explored factors associated with the use of England’s NHS Test and Trace service among parents of school-aged children.
Methods
One-to-one telephone interviews with parents (n = 18) of school-aged (4 to 18 years) children living in England between 30 November to 11 December 2020. Data were explored using thematic analysis.
Results
Three themes and eight sub-themes emerged. In terms of recognising symptoms of COVID-19, parents needed prompting before recalling the main symptoms described by the NHS. Parents suggested several factors relating to the nature of the symptom(s) and contextual information that might lead to or prevent them from seeking a test. Although parents supported symptomatic testing and described trusting official sources of information (e.g., Government and NHS websites). However, some concerns were raised regarding the accuracy of test results, safety at testing centres and logistics of testing but none of the concerns appeared to prevent engagement with testing. Parents perceived adherence to testing and self-isolation as pro-social behaviour, although family resources and circumstances impacted their ability to adhere fully.
Conclusions
Our study identified several barriers to parents using NHS Test and Trace as needed. Information about the eligibility of testing (main symptoms of COVID-19 and the age of eligibility) needs to be more precise and resources provided to enable families to adhere to self-isolation if the efficiency of test, trace and isolate systems is to be optimised.
Collapse
Affiliation(s)
- Lisa Woodland
- Department of Psychological Medicine, King’s College London, London, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, United Kingdom
- * E-mail:
| | - Fiona Mowbray
- Department of Psychological Medicine, King’s College London, London, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, United Kingdom
| | - Louise E. Smith
- Department of Psychological Medicine, King’s College London, London, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, United Kingdom
| | - Rebecca K. Webster
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, United Kingdom
- Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury, United Kingdom
| | - G James Rubin
- Department of Psychological Medicine, King’s College London, London, United Kingdom
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, United Kingdom
| |
Collapse
|
34
|
Smith LE, Potts HW, Amlôt R, Fear NT, Michie S, Rubin GJ. Who is engaging with lateral flow testing for COVID-19 in the UK? The COVID-19 Rapid Survey of Adherence to Interventions and Responses (CORSAIR) study. BMJ Open 2022; 12:e058060. [PMID: 35144956 PMCID: PMC8845094 DOI: 10.1136/bmjopen-2021-058060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate uptake of lateral flow testing, reporting of test results and psychological, contextual and socio-demographic factors associated with testing. DESIGN A series of four fortnightly online cross-sectional surveys. SETTING Data collected from 19 April 2021 to 2 June 2021. PARTICIPANTS People living in England and Scotland, aged 18 years or over, excluding those who reported their most recent test was a polymerase chain reaction (PCR) test (n=6646, n≈1600 per survey). MAIN OUTCOME MEASURES Having completed at least one lateral flow test (LFT) in the last 7 days. RESULTS We used binary logistic regressions to investigate factors associated with having taken at least one LFT. Increased uptake of testing was associated with being vaccinated (adjusted ORs (aORs)=1.52-2.45, 95% CI 1.25 to 3.07, analysed separately by vaccine dose), employed (aOR=1.94, 95% CI 1.63 to 2.32), having been out to work in the last week (aOR=2.30, 95% CI 1.94 to 2.73) and working in a sector that adopted LFT early (aOR=2.54, 95% CI 2.14 to 3.02) . Uptake was higher in people who reported cardinal COVID-19 symptoms in the last week (aOR=1.89, 95% CI 1.34 to 2.66). People who had heard more about LFTs (aOR=2.28, 95% CI 2.06 to 2.51) and knew they were eligible to receive regular LFTs (aOR=2.98, 95% CI 2.35 to 3.78) were also more likely to have tested. Factors associated with not taking a test included agreeing that you do not need to test for COVID-19 unless you have come into contact with a case (aOR=0.51, 95% CI 0.47 to 0.55). CONCLUSIONS Uptake of lateral flow testing is low. Encouraging testing through workplaces and places of study is likely to increase uptake, although care should be taken not to pressurise employees and students. Increasing knowledge that everyone is eligible for regular asymptomatic testing and addressing common misconceptions may drive uptake.
Collapse
Affiliation(s)
- Louise E Smith
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Henry Ww Potts
- Institute of Health Informatics, University College London, London, UK
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
- UK Health Security Agency, Salisbury, UK
| | - Nicola T Fear
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- King's Centre for Military Health Research and Academic Department of Military Mental Health, King's College London, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
| | - G James Rubin
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| |
Collapse
|
35
|
Smith LE, Potts HW, Amlȏt R, Fear NT, Michie S, Rubin GJ. Worry and behaviour at the start of the COVID-19 outbreak: Results from three UK surveys (the COVID-19 rapid survey of Adherence to Interventions and responses [CORSAIR] study). Prev Med Rep 2022; 25:101686. [PMID: 34976599 PMCID: PMC8711138 DOI: 10.1016/j.pmedr.2021.101686] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 12/22/2021] [Accepted: 12/26/2021] [Indexed: 12/31/2022] Open
Abstract
We aimed to describe worry and uptake of behaviours that prevent the spread of infection (respiratory and hand hygiene, distancing) in the UK at the start of the COVID-19 outbreak (January and February 2020) and to investigate factors associated with worry and adopting protective behaviours. Three cross-sectional online surveys of UK adults (28 to 30 January, n = 2016; 3 to 6 February, n = 2002; 10 to 13 February 2020, n = 2006) were conducted. We used logistic regressions to investigate associations between outcome measures (worry, respiratory and hand hygiene behaviour, distancing behaviour) and explanatory variables. 19.8% of participants (95% CI 18.8% to 20.8%) were very or extremely worried about COVID-19. People from minoritized ethnic groups were particularly likely to feel worried. 39.9% of participants (95% CI 37.7% to 42.0%) had completed one or more hand or respiratory hygiene behaviour more than usual in the last seven days. Uptake was associated with greater worry, perceived effectiveness of individual behaviours, self-efficacy for engaging in them, and having heard more information about COVID-19. 13.7% (95% CI 12.2% to 15.2%) had reduced the number of people they had met. This was associated with greater worry, perceived effectiveness, and self-efficacy. At the start of novel infectious disease outbreaks, communications should emphasise perceived effectiveness of behaviours and the ease with which they can be carried out.
Collapse
Affiliation(s)
- Louise E. Smith
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
| | | | - Richard Amlȏt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
- UK Health Security Agency, Behavioural Science and Insights Unit, UK
| | - Nicola T. Fear
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, UK
- King’s Centre for Military Health Research and Academic Department of Military Mental Health, King’s College London, UK
| | - Susan Michie
- University College London, Centre for Behaviour Change, UK
| | - G. James Rubin
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, UK
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
| |
Collapse
|
36
|
Smith LE, Potts HWW, Amlȏt R, Fear NT, Michie S, Rubin GJ. Intention to adhere to test, trace, and isolate during the COVID-19 pandemic (the COVID-19 Rapid Survey of Adherence to Interventions and Responses study). Br J Health Psychol 2021; 27:1100-1118. [PMID: 34846088 PMCID: PMC9542361 DOI: 10.1111/bjhp.12576] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/29/2021] [Indexed: 12/17/2022]
Abstract
Objectives (1) To investigate factors associated with intention to self‐isolate, request a test, and share details of close contacts when required. (2) To determine whether associations were stronger during periods when less stringent national COVID‐19 restrictions were in place. Design Series of cross‐sectional nationally representative surveys. We selected survey waves where different national restrictions were in place in England (first lockdown, summer release, second lockdown, third lockdown). Methods We investigated whether psychological factors and increased out‐of‐home activity in the last week were associated with intention to self‐isolate and request a test if you were to develop COVID‐19 symptoms, and intention to share details of contacts if you were to test positive. We also investigated whether the strength of associations differed by timepoint in the pandemic. Results Intention to self‐isolate, request a test and share details of contacts were associated with greater perceived risk of COVID‐19 to people in the United Kingdom, knowing that COVID‐19 transmission can be asymptomatic, and agreeing that personal behaviour has an impact on COVID‐19 transmission. There were few differences in strength of associations by timepoint suggesting these effects are broadly stable over time. Conclusions Psychological factors were associated with intention to adhere to key components of the contact tracing system; there was no evidence for an association with increased out‐of‐home activity. Messages that increase knowledge that COVID‐19 can be transmitted even if someone does not have symptoms and that an individual’s actions can contribute to the spread of the virus may promote engagement with the test, trace, and isolate system.
Collapse
Affiliation(s)
- Louise E Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| | - Henry W W Potts
- Institute of Health Informatics, University College London, UK
| | - Richard Amlȏt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK.,Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury, UK
| | - Nicola T Fear
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,Academic Department of Military Mental Health, King's Centre for Military Health Research, London, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, UK
| | - G James Rubin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,NIHR Health Protection Research Unit in Emergency Preparedness and Response, London, UK
| |
Collapse
|
37
|
Smith LE, Serfioti D, Weston D, Greenberg N, Rubin GJ. Adherence to protective measures among healthcare workers in the UK: a cross-sectional study. Emerg Med J 2021; 39:100-105. [PMID: 34848560 PMCID: PMC8788253 DOI: 10.1136/emermed-2021-211454] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 11/10/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Healthcare workers (HCWs) are frontline responders to emergency infectious disease outbreaks such as COVID-19. To avoid the rapid spread of disease, adherence to protective measures is paramount. We investigated rates of correct use of personal protective equipment (PPE), hand hygiene and physical distancing in UK HCWs who had been to their workplace at the start of the COVID-19 pandemic and factors associated with adherence. METHODS We used an online cross-sectional survey of 1035 UK healthcare professionals (data collected 12-16 June 2020). We excluded those who had not been to their workplace in the previous 6 weeks, leaving us with a sample size of 831. Respondents were asked about their use of PPE, hand hygiene and physical distancing in the workplace. Frequency of uptake was reported descriptively; adjusted logistic regressions were used to separately investigate factors associated with adherence to use of PPE, maintaining good hand hygiene and physical distancing from colleagues. RESULTS Adherence to personal protective measures was suboptimal (PPE use: 80.0%, 95% CI 77.3 to 82.8; hand hygiene: 67.8%, 95% CI 64.6 to 71.0; coming into close contact with colleagues: 74.7%, 95% CI 71.7 to 77.7). Adherence to PPE use was associated with having received training about health and safety in the workplace for COVID-19, greater perceived social pressure to adopt the behaviour and availability of PPE. Non-adherence was associated with fatalism about COVID-19 and greater perceived difficulty of adopting protective measures. Workplace design using markings to facilitate distancing was associated with adherence to physical distancing. CONCLUSIONS Uptake of personal protective behaviours among UK HCWs at the start of the pandemic was variable. Factors associated with adherence provide insight into ways to support HCWs to adopt personal protective behaviours, such as ensuring that adequate PPE is available and designing workplaces to facilitate physical distancing.
Collapse
Affiliation(s)
- Louise E Smith
- Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | | | - Dale Weston
- Behavioural Science Team, UK Health Security Agency, London, UK
| | - Neil Greenberg
- Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| | - G James Rubin
- Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
38
|
Smith LE, Sim J, Amlôt R, Cutts M, Dasch H, Sevdalis N, Rubin GJ, Sherman SM. Side-effect expectations from COVID-19 vaccination: Findings from a nationally representative cross-sectional survey (CoVAccS - wave 2). J Psychosom Res 2021; 152:110679. [PMID: 34823113 PMCID: PMC8595305 DOI: 10.1016/j.jpsychores.2021.110679] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Concern about side effects is one of the most common reasons for refusing vaccination. Side-effect expectations are known to predict perception of side effects. We aimed to investigate the percentage of people who thought side effects from COVID-19 vaccination were likely and investigate factors associated with side-effect expectation. METHODS Online cross-sectional survey of 1470 UK adults who had not been vaccinated for COVID-19 (conducted 13 to 15 January 2021). We asked participants how likely they thought side effects from COVID-19 vaccination were. Linear regression analyses were used to investigate associations with side-effect expectations. RESULTS Most participants were uncertain whether they would experience side effects from a COVID-19 vaccine; only a minority reported that side effects were very likely (9.4%, 95% CI 7.9% to 10.9%, n = 138/1470). Personal and clinical characteristics, general, and COVID-19 vaccination beliefs and attitudes explained 29.7% of the variance in side-effect expectation, with COVID-19 vaccination beliefs alone accounting for 17.2%. Side-effect expectations were associated with: older age, being clinically extremely vulnerable to COVID-19, being afraid of needles, lower perceived social norms for COVID-19 vaccination, lower perceived necessity and safety of COVID-19 vaccination, and perceived lack of information about COVID-19 and vaccination. CONCLUSIONS Side-effect expectation was associated with believing that COVID-19 vaccination was unsafe, ineffective and that others would be less likely to approve of you having a COVID-19 vaccination. Communications should emphasise the safety, effectiveness, and widespread uptake of vaccination, while promoting accurate perceptions of the incidence of vaccination side effects.
Collapse
Affiliation(s)
- Louise E Smith
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK.
| | - Julius Sim
- Keele University, School of Medicine, UK
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK; UK Health Security Agency, Behavioural Science and Insights Unit, UK
| | | | - Hannah Dasch
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; King's College London, Centre for Implementation Science, UK
| | - Nick Sevdalis
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; King's College London, Centre for Implementation Science, UK
| | - G James Rubin
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
| | | |
Collapse
|
39
|
Sherman SM, Sim J, Cutts M, Dasch H, Amlôt R, Rubin GJ, Sevdalis N, Smith LE. COVID-19 vaccination acceptability in the UK at the start of the vaccination programme: a nationally representative cross-sectional survey (CoVAccS - wave 2). Public Health 2021; 202:1-9. [PMID: 34856520 PMCID: PMC8520876 DOI: 10.1016/j.puhe.2021.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 01/14/2023]
Abstract
Objectives Investigate factors associated with the intention to have the COVID-19 vaccination following initiation of the UK national vaccination programme. Study design An online cross-sectional survey completed by 1500 adults (13th–15th January 2021). Methods Linear regression analyses were used to investigate associations between intention to be vaccinated for COVID-19 and sociodemographic factors, previous influenza vaccination, attitudes and beliefs about COVID-19 and COVID-19 vaccination and vaccination in general. Participants’ main reasons for likely vaccination (non-)uptake were also solicited. Results 73.5% of participants (95% CI 71.2%, 75.7%) reported being likely to be vaccinated against COVID-19, 17.3% (95% CI 15.4%, 19.3%) were unsure, and 9.3% (95% CI 7.9%, 10.8%) reported being unlikely to be vaccinated. The full regression model explained 69.8% of the variance in intention. Intention was associated with: having been/intending to be vaccinated for influenza last winter/this winter; stronger beliefs about social acceptability of a COVID-19 vaccine; the perceived need for vaccination; adequacy of information about the vaccine; and weaker beliefs that the vaccine is unsafe. Beliefs that only those at serious risk of illness should be vaccinated and that the vaccines are just a means for manufacturers to make money were negatively associated with vaccination intention. Conclusions Most participants reported being likely to get the COVID-19 vaccination. COVID-19 vaccination attitudes and beliefs are a crucial factor underpinning vaccine intention. Continued engagement with the public with a focus on the importance and safety of vaccination is recommended.
Collapse
Affiliation(s)
| | - J Sim
- Keele University, School of Medicine, UK
| | - M Cutts
- Keele University, School of Psychology, UK
| | - H Dasch
- King's College London, Centre for Implementation Science, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - R Amlôt
- Public Health England, Behavioural Science Team, Emergency Response Department Science and Technology, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
| | - G J Rubin
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
| | - N Sevdalis
- King's College London, Centre for Implementation Science, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - L E Smith
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
| |
Collapse
|
40
|
Smith LE, Potts HWW, Amlȏt R, Fear NT, Michie S, Rubin GJ. Holding a stigmatizing attitude at the start of the COVID-19 outbreak: A cross-sectional survey. Br J Health Psychol 2021; 27:588-604. [PMID: 34606149 PMCID: PMC8646234 DOI: 10.1111/bjhp.12564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/24/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To identify the prevalence of a stigmatizing attitude towards people of Chinese origin at the start of the COVID-19 outbreak in the UK population and investigate factors associated with holding the stigmatizing attitude. DESIGN Online cross-sectional survey conducted 10-13 February 2020 (n = 2006, people aged 16 years or over and living in the UK). METHODS We asked participants to what extent they agreed it was best to avoid areas heavily populated by Chinese people because of the COVID-19 outbreak. Survey materials also asked about: worry, perceived risk, knowledge, information receipt, perception of government response to COVID-19, and personal characteristics. We ran binary logistic regressions to investigate associations between holding a stigmatizing attitude, personal characteristics, and psychological and contextual factors. RESULTS 26.1% people (95% CI 24.2-28.0%, n = 524/2006) agreed it was best to avoid areas heavily populated by Chinese people. Holding a stigmatizing attitude was associated with greater worry about COVID-19, greater perceived risk of COVID-19, and poorer knowledge about COVID-19. CONCLUSIONS At the start of the COVID-19 pandemic, a large percentage of the UK public endorsed avoiding areas in the UK heavily populated by people of Chinese origin. This attitude was associated with greater worry about, and perceived risk of, the COVID-19 outbreak as well as poorer knowledge about COVID-19. At the start of future novel infectious disease outbreaks, proactive communications from official sources should provide context and facts to reduce uncertainty and challenge stigmatizing attitudes, to minimize harms to affected communities.
Collapse
Affiliation(s)
- Louise E Smith
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK.,NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
| | - Henry W W Potts
- University College London, Institute of Health Informatics, UK
| | - Richard Amlȏt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK.,Emergency Response Department Science and Technology, Public Health England, Behavioural Science Team, UK
| | - Nicola T Fear
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK.,Academic Department of Military Mental Health, King's Centre for Military Health Research, UK
| | - Susan Michie
- Centre for Behaviour Change, University College London, UK
| | - G James Rubin
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK.,NIHR Health Protection Research Unit in Emergency Preparedness and Response, UK
| |
Collapse
|
41
|
Denford S, Morton KS, Lambert H, Zhang J, Smith LE, Rubin GJ, Cai S, Zhang T, Robin C, Lasseter G, Hickman M, Oliver I, Yardley L. Understanding patterns of adherence to COVID-19 mitigation measures: a qualitative interview study. J Public Health (Oxf) 2021; 43:508-516. [PMID: 33559682 PMCID: PMC7928806 DOI: 10.1093/pubmed/fdab005] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Evidence highlights the disproportionate impact of measures that have been introduced to reduce the spread of coronavirus on individuals from Black, Asian and minority ethnic (BAME) communities, and among those on a low income. An understanding of barriers to adherence in these populations is needed. In this qualitative study, we examined the patterns of adherence to mitigation measures and reasons underpinning these behaviors. METHODS Semi-structured interviews were conducted with 20 participants from BAME and low-income White backgrounds. The topic guide was designed to explore how individuals are adhering to social distancing and self-isolation during the pandemic and to explore the reasons underpinning this behavior. RESULTS We identified three categories of adherence to lockdown measures: (i) caution-motivated super-adherence (ii) risk-adapted partial-adherence and (iii) necessity-driven partial-adherence. Decisions about adherence considered potential for exposure to the virus, ability to reduce risk through use of protective measures and perceived importance of/need for the behavior. CONCLUSIONS This research highlights a need for a more nuanced understanding of adherence to lockdown measures. Provision of practical and financial support could reduce the number of people who have to engage in necessity-driven partial-adherence. More evidence is required on population level risks of people adopting risk-adapted partial-adherence.
Collapse
Affiliation(s)
- Sarah Denford
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
- School of Psychological Science, University of Bristol, Bristol BS8 1TU, UK
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol in collaboration with Public Health, UK
| | - Kate S Morton
- Academic Unit of Psychology, University of Southampton, Southampton SO17 1BJ, UK
| | - Helen Lambert
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol in collaboration with Public Health, UK
| | - Juan Zhang
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
| | - Louise E Smith
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King’s College London, London SE5 9RJ, UK
- Department of Psychological Medicine, King’s College London, London WC2R 2LS, UK
| | - G James Rubin
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King’s College London, London SE5 9RJ, UK
- Department of Psychological Medicine, King’s College London, London WC2R 2LS, UK
| | - Shenghan Cai
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
| | - Tingting Zhang
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
| | - Charlotte Robin
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol in collaboration with Public Health, UK
- Public Health England, National Infection Service, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool L69 7BE, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool L69 3BX, UK
| | - Gemma Lasseter
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol in collaboration with Public Health, UK
| | - Mathew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol in collaboration with Public Health, UK
| | - Isabel Oliver
- Public Health England, National Infection Service, Bristol BS1 6EH, UK
| | - Lucy Yardley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1UD, UK
- School of Psychological Science, University of Bristol, Bristol BS8 1TU, UK
- NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol in collaboration with Public Health, UK
- Academic Unit of Psychology, University of Southampton, Southampton SO17 1BJ, UK
| |
Collapse
|
42
|
Smith LE, Potts HWW, Amlȏt R, Fear NT, Michie S, Rubin GJ. Do members of the public think they should use lateral flow tests (LFT) or polymerase chain reaction (PCR) tests when they have COVID-19-like symptoms? The COVID-19 Rapid Survey of Adherence to Interventions and Responses study. Public Health 2021; 198:260-262. [PMID: 34487869 PMCID: PMC8316130 DOI: 10.1016/j.puhe.2021.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
Objectives This study aimed to investigate public use of lateral flow tests (LFT) and polymerase chain reaction (PCR) tests when experiencing key COVID-19 symptoms. Study design In this study, data from two waves of a cross-sectional nationally representative online survey (data collected 1 and 2 June, and 14 and 15 June 2021; n = 3665 adults aged ≥18 years living in England or Scotland) were used. Methods We report data investigating which type of test, if any, the public think Government guidance asks people to use if they have COVID-19 symptoms. In people with key COVID-19 symptoms (high temperature / fever; new, continuous cough; loss of sense of smell; loss of taste), we also describe the uptake of testing, if any. Results Ten percent of respondents thought Government guidance stated that they should take an LFT if symptomatic, whereas 18% of people thought that they should take a PCR test; 60% of people thought they should take both types of test (12% did not select either option). In people who were symptomatic, 32% reported taking a test to confirm whether they had COVID-19. Of these, 53% reported taking a PCR test and 44% reported taking an LFT. Conclusions Despite Government guidance stating that anyone with key COVID-19 symptoms should complete a PCR test, a significant percentage of the population use LFT tests when symptomatic. Communications should emphasise the superiority of, and need for, PCR tests in people with symptoms.
Collapse
Affiliation(s)
- L E Smith
- Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK.
| | - H W W Potts
- Institute of Health Informatics, University College London, Institute of Health Informatics, 222 Euston Road, London, NW1 2DA, UK
| | - R Amlȏt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK; Behavioural Science and Insights Unit, Public Health England, Behavioural Science and Insights Unit, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK
| | - N T Fear
- Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK; Academic Department of Military Mental Health, King's Centre for Military Health Research, London, UK
| | - S Michie
- Centre for Behaviour Change, University College London, Centre for Behaviour Change, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - G J Rubin
- Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK; NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK
| |
Collapse
|
43
|
Mowbray F, Woodland L, Smith LE, Amlôt R, Rubin GJ. Is My Cough a Cold or Covid? A Qualitative Study of COVID-19 Symptom Recognition and Attitudes Toward Testing in the UK. Front Public Health 2021; 9:716421. [PMID: 34485238 PMCID: PMC8416344 DOI: 10.3389/fpubh.2021.716421] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/26/2021] [Indexed: 01/09/2023] Open
Abstract
Objective: Key to reducing the spread of COVID-19 in the UK is increased use of the NHS Test and Trace (NHSTT) system. This study explored one of the main issues that determine whether people engage with NHSTT, how people understand symptoms that may indicate the presence of COVID-19 and that should trigger a request for a test. Methods: In this qualitative study, a series of semi-structured telephone interviews were conducted with 40 people (21 members of the general population, 19 students). There was nearly an equal split between male and female participants in both samples. Data were collected between 30 November and 11 December 2020 and explored using thematic analysis. There was substantial similarity in responses for both populations so we combined our results and highlighted where differences were present. Results: Participants generally had good knowledge of the main symptoms of COVID-19 (high temperature, new, persistent cough, anosmia) but had low confidence in their ability to differentiate them from symptoms of other illnesses. Attribution of symptoms to COVID-19 was most likely where the symptoms were severe, many symptoms were present, symptoms had lasted for some time and when perceived risk of exposure to infection was high due to previous contact with others. Participants felt encouraged to engage in testing where symptoms were present and had persisted for several days, though, many had concerns about the safety of testing centres and the accuracy of test results. Students had mixed feelings about mass asymptomatic testing, seeing it as a way to access a more normal student experience, but also a potential waste of resources. Conclusions: This study offers novel insights into how people attribute symptoms to COVID-19 and barriers and facilitators to engaging with NHSTT. Participants had positive views of testing, but there is a need to improve not just recognition of each main symptom, but also understanding that even single, mild symptoms may necessitate a test rather than a “wait and see” approach, and to address concerns around test accuracy to increase testing uptake.
Collapse
Affiliation(s)
- Fiona Mowbray
- Weston Education Centre, King's College London, London, United Kingdom
| | - Lisa Woodland
- Weston Education Centre, King's College London, London, United Kingdom
| | - Louise E Smith
- Weston Education Centre, King's College London, London, United Kingdom
| | - Richard Amlôt
- Emergency Response Department, Public Health England, Salisbury, United Kingdom
| | - G James Rubin
- Weston Education Centre, King's College London, London, United Kingdom
| |
Collapse
|
44
|
Michie S, Potts HWW, West R, Amlȏt R, Smith LE, Fear NT, Rubin GJ. Factors associated with non-essential workplace attendance during the COVID-19 pandemic in the UK in early 2021: evidence from cross-sectional surveys. Public Health 2021; 198:106-113. [PMID: 34411993 PMCID: PMC8463075 DOI: 10.1016/j.puhe.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022]
Abstract
Objectives Working from home where possible is important in reducing the spread of COVID-19. In early 2021, a quarter of people in England who believed they could work entirely from home reported attending their workplace. To inform interventions to reduce this, this study examined associated factors. Study design Data from the ongoing COVID-19 Rapid Survey of Adherence to Interventions and Responses survey series of nationally representative samples of people in the UK aged 16+ years in January–February 2021 were used. Methods The study sample was 1422 respondents who reported that they could work completely from home. The outcome measure was self-reported workplace attendance at least once during the preceding week. Factors of interest were analysed in three blocks: 1) sociodemographic variables, 2) variables relating to respondents’ circumstances and 3) psychological variables. Results 26.8% (95% confidence interval [CI] = 24.5%–29.1%) of respondents reported having attended their workplace at least once in the preceding week. Sociodemographic variables and living circumstances significantly independently predicted non-essential workplace attendance: male gender (odds ratio [OR] = 1.85, 95% CI = 1.33–2.58); dependent children in the household (OR = 1.65, 95% CI = 1.17–2.32); financial hardship (OR = 1.14, 95% CI = 1.08–1.21); lower socio-economic grade (C2DE; OR = 1.65, 95% CI = 1.19–2.53); working in sectors such as health or social care (OR = 4.18, 95% CI = 2.56–6.81), education and childcare (OR = 2.45, 95% CI = 1.45–4.14) and key public service (OR = 3.78, 95% CI = 1.83–7.81) and having been vaccinated (OR = 2.08, 95% CI = 1.33–3.24). Conclusions Non-essential workplace attendance in the UK in early 2021 during the COVID-19 pandemic was significantly independently associated with a range of sociodemographic variables and personal circumstances. Having been vaccinated, financial hardship, socio-economic grade C2DE, having a dependent child at home and working in certain key sectors were associated with higher likelihood of workplace attendance.
Collapse
Affiliation(s)
- S Michie
- University College London, Centre for Behaviour Change, United Kingdom.
| | - H W W Potts
- University College London, Institute of Health Informatics, United Kingdom
| | - R West
- University College London, Department of Behavioural Science and Health, United Kingdom
| | - R Amlȏt
- Public Health England, Behavioural Science Team, Emergency Response Department Science and Technology, United Kingdom; NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom; Porton Down, Salisbury, Wiltshire, United Kingdom
| | - L E Smith
- King's College London, Department of Psychological Medicine, United Kingdom; NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom
| | - N T Fear
- King's College London, Department of Psychological Medicine, United Kingdom; King's College London, King's Centre for Military Health Research and Academic Department of Military Mental Health, United Kingdom
| | - G J Rubin
- King's College London, Department of Psychological Medicine, United Kingdom; NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom
| |
Collapse
|
45
|
Brooks SK, Greenberg N, Wessely S, Rubin GJ. Factors affecting healthcare workers' compliance with social and behavioural infection control measures during emerging infectious disease outbreaks: rapid evidence review. BMJ Open 2021; 11:e049857. [PMID: 34400459 PMCID: PMC8370838 DOI: 10.1136/bmjopen-2021-049857] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The 2019-2020 outbreak of novel coronavirus has raised concerns about nosocomial transmission. This review's aim was to explore the existing literature on emerging infectious disease outbreaks to identify factors associated with compliance with infection control measures among healthcare staff. METHODS A rapid evidence review for primary studies relevant to healthcare workers' compliance with infection control measures. RESULTS Fifty-six papers were reviewed. Staff working in emergency or intensive care settings or with contact with confirmed cases appeared more likely to comply with recommendations. There was some evidence that anxiety and concern about the risk of infection were more associated with compliance, and that monitoring from superiors could improve compliance. Observed non-compliance of colleagues could hinder compliance. Staff identified many barriers to compliance related to personal protective equipment, including availability, perceived difficulty and effectiveness, inconvenience, discomfort and a negative impact on patient care. There were many issues regarding the communication and ease of understanding of infection control guidance. CONCLUSION We recommend provision of training and education tailored for different occupational roles within the healthcare setting, managerial staff 'leading by example', ensuring adequate resources for infection control and timely provision of practical evidence-based infection control guidelines.
Collapse
Affiliation(s)
- Samantha K Brooks
- Department of Psychological Medicine, King's College London, London, UK
| | - N Greenberg
- Department of Psychological Medicine, King's College London, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, King's College London, London, UK
| | - G J Rubin
- Department of Psychological Medicine, King's College London, London, UK
| |
Collapse
|
46
|
Denford S, Martin AF, Love N, Ready D, Oliver I, Amlôt R, Yardley L, Rubin GJ. Engagement With Daily Testing Instead of Self-Isolating in Contacts of Confirmed Cases of SARS-CoV-2: A Qualitative Analysis. Front Public Health 2021; 9:714041. [PMID: 34414160 PMCID: PMC8369371 DOI: 10.3389/fpubh.2021.714041] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: In December 2020 and January 2021 Public Health England (PHE) with NHS Test and Trace conducted a study to explore the feasibility and acceptability of daily testing as an alternative to self-isolation following close contact with a confirmed COVID-19 case. This qualitative paper aims to identify factors influencing uptake among those offered daily testing, and the subsequent impact on behaviour. Methods: We conducted in-depth interviews with 52 participants who had taken part in the feasibility study. Participants were asked about their experiences of daily testing or self-isolating, their reasons for choosing to test or isolate, and their behaviour during the study period. Data were analysed using inductive thematic analysis. Results: Results are presented under two main headings: (1) factors influencing acceptance of testing and (2) impact of test results. Participants appeared highly motivated to engage in behaviours that would protect others from the virus. Factors influencing the decision to accept testing included (1) needing to avoid self-isolation, (2) concerns about test sensitivity, and (3) perceived benefits of detecting infection. Participants who were taking tests reported: (1) positive consequences following confirmation of COVID status, (2) engaging in essential activities, (3) uncertainty, and (4) self-isolating whilst testing. Conclusions: This study has identified a range of factors that appear to influence the decision to engage in daily testing or to self-isolate following close contact with a positive case, many of which could be addressed by clear communications. Covid-19 infection rates and government restrictions influenced experiences, and so further research is needed to explore perceptions of daily testing and behaviour following close contact with a positive case among a wider range of individuals, in the context of lower rates of COVID-19, few government restrictions on general population behaviour and more widespread testing.
Collapse
Affiliation(s)
- Sarah Denford
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Alex F. Martin
- Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom
| | - Nicola Love
- National Infection Service, Public Health England, Bristol, United Kingdom
| | - Derren Ready
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- National Infection Service, Public Health England, Bristol, United Kingdom
| | - Isabel Oliver
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- National Infection Service, Public Health England, Bristol, United Kingdom
| | - Richard Amlôt
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom
- Behavioural Science Team, Emergency Response Department Science and Technology, Public Health England, Salisbury, United Kingdom
| | - Lucy Yardley
- Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - G. James Rubin
- Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, United Kingdom
| |
Collapse
|
47
|
Carter H, Weston D, Greenberg N, Oliver I, Robin C, Rubin GJ, Wessely S, Gauntlett L, Amlot R. Experiences of supported isolation in returning travellers during the early COVID-19 response: a qualitative interview study. BMJ Open 2021; 11:e050405. [PMID: 34301664 PMCID: PMC8313304 DOI: 10.1136/bmjopen-2021-050405] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES (1) To understand the experiences and perceptions of those who underwent supported isolation, particularly in relation to factors that were associated with improved compliance and well-being; (2) to inform recommendations for the management of similar supported isolation procedures. DESIGN We carried out a qualitative study using semistructured interviews to capture participants' experiences and perceptions of supported isolation. Data were analysed using the framework approach, a type of thematic analysis that is commonly used in research that has implications for policy. SETTING Telephone interviews carried out within approximately 1 month of an individual leaving supported isolation. PARTICIPANTS 26 people who underwent supported isolation at either Arrowe Park Hospital (n=18) or Kents Hill Park Conference Centre (n=8) after being repatriated from Wuhan in January to February 2020. RESULTS Six key themes were identified: factors affecting compliance with supported isolation; risk perceptions around catching COVID-19; management of supported isolation; communication with those outside supported isolation; relationship with others in supported isolation; and feelings on leaving supported isolation. Participants were willing to undergo supported isolation because they understood that it would protect themselves and others. Positive treatment by staff was fundamental to participants' willingness to comply with isolation procedures. Despite the high level of compliance, participants expressed some uncertainty about what the process would involve. CONCLUSIONS As hotel quarantine is introduced across the UK for international arrivals, our findings suggest that those in charge should: communicate effectively before, during and after quarantine, emphasising why quarantine is important and how it will protect others; avoid coercion if possible and focus on supporting and promoting voluntary compliance; facilitate shared social experiences for those in quarantine; and ensure all necessary supplies are provided. Doing so is likely to increase adherence and reduce any negative effects on well-being.
Collapse
Affiliation(s)
- Holly Carter
- Behavioural Science and Insights Unit, Public Health England, Porton Down, Salisbury, UK
| | - Dale Weston
- Behavioural Science and Insights Unit, Public Health England, Porton Down, Salisbury, UK
| | - Neil Greenberg
- Department of Psychological Medicine, King's College London, Weston Education Centre, London, UK
| | - Isabel Oliver
- National Infection Service, Public Health England, Bristol, UK
| | - Charlotte Robin
- Behavioural Science and Insights Unit, Public Health England, Porton Down, Salisbury, UK
| | - G James Rubin
- Department of Psychological Medicine, King's College London, Weston Education Centre, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, King's College London, Weston Education Centre, London, UK
| | - Louis Gauntlett
- Behavioural Science and Insights Unit, Public Health England, Porton Down, Salisbury, UK
| | - Richard Amlot
- Behavioural Science and Insights Unit, Public Health England, Porton Down, Salisbury, UK
| |
Collapse
|
48
|
Sherman SM, Sim J, Amlôt R, Cutts M, Dasch H, Rubin GJ, Sevdalis N, Smith LE. Intention to have the seasonal influenza vaccination during the COVID-19 pandemic among eligible adults in the UK: a cross-sectional survey. BMJ Open 2021; 11:e049369. [PMID: 34257095 PMCID: PMC8282414 DOI: 10.1136/bmjopen-2021-049369] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate the likelihood of having the seasonal influenza vaccination during the COVID-19 pandemic in individuals who were eligible to receive it. DESIGN We conducted a cross-sectional online survey in July 2020. We included predictors informed by previous research, in the following categories: sociodemographic variables; uptake of influenza vaccine last winter and beliefs about vaccination. PARTICIPANTS 570 participants (mean age: 53.07; 56.3% female, 87.0% white) who were eligible for the free seasonal influenza vaccination in the UK. RESULTS 59.7% of our sample indicated they were likely to have the seasonal influenza vaccination, 22.1% reported being unlikely to have the vaccination and 18.2% were unsure. We used logistic regression to investigate variables associated with intention to receive a seasonal influenza vaccine in the 2020-2021 season. A positive attitude to vaccination in general predicted intention to have the influenza vaccine in 2020-2021 (OR 1.45, 95% CI 1.19 to 1.77, p<0.001) but the strongest predictor of intention was previous influenza vaccination behaviour (OR 278.58, 95% CI 78.04 to 994.46, p<0.001). CONCLUSIONS Previous research suggests that increasing uptake of the influenza vaccination may help contain a COVID-19 outbreak, so steps need to be taken to convert intention into behaviour and to reach those individuals who reported being unlikely or unsure about having the vaccine.
Collapse
Affiliation(s)
| | - Julius Sim
- School of Medicine, Keele University, Keele, UK
| | - Richard Amlôt
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
- Emergency Response Department Science and Technology, Public Health England, Salisbury, UK
| | - Megan Cutts
- School of Psychology, Keele University, Keele, UK
| | - Hannah Dasch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Implementation Science, King's College London, London, UK
| | - G James Rubin
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nick Sevdalis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Implementation Science, King's College London, London, UK
| | - Louise E Smith
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, King's College London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
49
|
Drury J, Mao G, John A, Kamal A, Rubin GJ, Stott C, Vandrevala T, Marteau TM. Behavioural responses to Covid-19 health certification: a rapid review. BMC Public Health 2021; 21:1205. [PMID: 34162364 PMCID: PMC8221819 DOI: 10.1186/s12889-021-11166-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/27/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Covid-status certification - certificates for those who test negative for the SARS-CoV-2 virus, test positive for antibodies, or who have been vaccinated against SARS-CoV-2 - has been proposed to enable safer access to a range of activities. Realising these benefits will depend in part upon the behavioural and social impacts of certification. The aim of this rapid review was to describe public attitudes towards certification, and its possible impact on uptake of testing and vaccination, protective behaviours, and crime. METHOD A search was undertaken in peer-reviewed databases, pre-print databases, and the grey literature, from 2000 to December 2020. Studies were included if they measured attitudes towards or behavioural consequences of health certificates based on one of three indices of Covid-19 status: test-negative result for current infectiousness, test-positive for antibodies conferring natural immunity, or vaccination(s) conferring immunity. RESULTS Thirty-three papers met the inclusion criteria, only three of which were rated as low risk of bias. Public attitudes were generally favourable towards the use of immunity certificates for international travel, but unfavourable towards their use for access to work and other activities. A significant minority was strongly opposed to the use of certificates of immunity for any purpose. The limited evidence suggested that intention to get vaccinated varied with the activity enabled by certification or vaccination (e.g., international travel). Where vaccination is seen as compulsory this could lead to unwillingness to accept a subsequent vaccination. There was some evidence that restricting access to settings and activities to those with antibody test certificates may lead to deliberate exposure to infection in a minority. Behaviours that reduce transmission may decrease upon health certificates based on any of the three indices of Covid-19 status, including physical distancing and handwashing. CONCLUSIONS The limited evidence suggests that health certification in relation to COVID-19 - outside of the context of international travel - has the potential for harm as well as benefit. Realising the benefits while minimising the harms will require real-time evaluations allowing modifications to maximise the potential contribution of certification to enable safer access to a range of activities.
Collapse
Affiliation(s)
- John Drury
- School of Psychology, University of Sussex, Brighton, UK
| | - Guanlan Mao
- School of Psychology, University of Sussex, Brighton, UK
| | - Ann John
- Swansea University, Population Data Science, Swansea, UK
| | - Atiya Kamal
- Department of Psychology, Birmingham City University, Birmingham, UK
| | - G. James Rubin
- Department of Psychological Medicine, King’s College London, London, UK
| | | | - Tushna Vandrevala
- Department of Psychology, Kingston University, Kingston upon Thames, UK
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| |
Collapse
|
50
|
Smith LE, Hodson A, Rubin GJ. Parental attitudes towards mandatory vaccination; a systematic review. Vaccine 2021; 39:4046-4053. [PMID: 34140173 DOI: 10.1016/j.vaccine.2021.06.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Uptake of childhood vaccines is decreasing. While mandatory vaccination schemes can increase vaccine uptake rates, they can also cause backlash among some parents. We conducted a systematic review investigating parental beliefs about vaccine mandates and factors associated with support for mandatory vaccination schemes. We searched Embase, Ovid MEDLINE, Global Health, APA PsycINFO and Web of Science from inception to 17th September 2020. Seventeen studies (five qualitative, twelve quantitative) were eligible for inclusion. We synthesised results of qualitative and quantitative studies separately. As quantitative studies were heterogeneous in the mandatory vaccination schemes and associated factors investigated, there was no scope to conduct a meta-analysis. Instead, data were narratively synthesised, considering risk of bias ratings. Qualitative data were synthesised using meta-ethnography, synthesising themes reported across studies included. Quantitative studies reported that support for mandatory vaccination schemes was reasonably high (73% to 88%). However, due to heterogeneity, there was little evidence for any factors being consistently associated with support for mandatory vaccination. Qualitative studies gave an insight into how parents perceive mandatory vaccination. Studies found that parents perceived mandatory vaccination schemes as an infringement of their rights, and particularly disliked schemes offering financial incentives for vaccination. Nevertheless, some parents felt that schemes limiting access to schooling of unvaccinated children gave them "peace of mind." Results should be taken with caution due to the purposive use of non-representative samples. Before deciding to mandate vaccination, it is important to understand the impact it could have on parental beliefs and attitudes about vaccination.
Collapse
Affiliation(s)
- Louise E Smith
- King's College London, Department of Psychological Medicine, United Kingdom; NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom.
| | - Ava Hodson
- NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom; King's College London, Department of War Studies, United Kingdom
| | - G James Rubin
- King's College London, Department of Psychological Medicine, United Kingdom; NIHR Health Protection Research Unit in Emergency Preparedness and Response, United Kingdom
| |
Collapse
|