Behavioural barriers to COVID-19 testing in Australia

Abstract

Background: The current suppression strategy for COVID-19 in Australia is dependent on people getting tested and self-isolating while they have COVID-19 symptoms. However, there is very little research on the behaviours and behavioural barriers involved in getting tested, both in Australia and worldwide, despite there being some evidence that these barriers do exist. Methods: The Sydney Health Literacy Lab (SHeLL) has been conducting a national longitudinal survey in Australia since April 2020. A list of testing barriers was included in Wave 3 in June 2020 (n=1369), along with intentions to test and self-isolate if symptomatic. Open responses were also collected. The test barriers identified were categorised using the COM-B framework. Results: Only 49% of people strongly agreed they would get tested if they had COVID-19 symptoms, but most people agreed to some extent that they would get tested (96%). The most common barriers selected from the list provided were that testing is painful (11%), not knowing how to get tested (7%), and worry about getting infected at the testing centre (5%). Many participants (10%) indicated other reasons, and open responses included many additional barriers to testing than those provided in the initial list. These covered all components of the COM-B model. Conclusion: We identified a wide range of barriers using both quantitative and qualitative methods, which need to be addressed in order to increase COVID-19 testing behaviour.

Knowledge, Attitudes, and Behavior Related to COVID-19 Testing: A Rapid Scoping Review

“…Lateral flow testing is less widely represented in the evidence base and is more likely to feature in articles and preprints based on more recently collected data [ 22 , 38 ]. The characteristics of all studies included in the review are summarized in Table 1 [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 …”

“…Studies that explored facilitating factors included research on participants’ knowledge and awareness of testing types and how they work [ 36 , 44 ] and research on people’s identification and interpretation of COVID-19 symptoms, including how this affects test-seeking behavior [ 30 , 45 , 46 , 47 ]. Multiple studies in this research area gathered data on people’s self-reported motivations for undergoing or avoiding testing [ 22 , 23 , 24 , 26 , 27 , 29 , 30 , 32 , 35 , 37 , 38 , 40 , 41 , 42 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. Some of these studies sought to gather data on people’s trust in the government and/or medical systems in relation to COVID-19 testing [ 24 , 41 , 54 , 55 ] or piloted ways to improve people’s levels of trust in testing [ 42 ].…”

“…4.1.4. Social Solidarity, Peer-Pressure, and Stigma Social pressure (e.g., relating to the expected reactions of employers, friends, and family to an individual's decision to seek testing or test result) was a sub-focus of 14 studies in this review [23,24,26,27,32,33,38,40,45,46,48,54,67]. Six studies focused on negative pressure from employers and peers [38,40,45,46] or stigma [54,67] as barriers to testing.…”

“…In four studies, members of the public reported confusion and uncertainty regarding how to access or where to go for testing, suggesting that public awareness of testing systems is an important factor in testing uptake [ 30 , 47 , 48 , 50 ]. In particular, participants reported not knowing where to go to get tested [ 30 , 47 , 50 ].…”

Testing children with COVID‐19 symptoms: what are parents’ intentions?

“…There is little published research exploring why some parents may not present children for COVID‐19 testing. A recent Australian study has identified barriers to testing among adults, including a belief that testing is painful, a lack of knowledge about how to get tested, and worry about getting infected at the testing centre 3 . These barriers may also apply to parents in relation to testing for children.…”