Changes in public health-seeking behaviours for self-limiting respiratory tract infections across England during the COVID-19 pandemic

Abstract

Background National Health Service (NHS) guidance for acute respiratory tract infections (RTIs) advocates self-care, encourages utilization of local pharmacies and recommends consulting general practitioners (GPs) primarily for the vulnerable or those with persistent symptoms. Coronavirus disease 2019 exerted substantial strain on the English NHS, affecting public access to primary care services. Methods For 3 years, public surveys assessed RTI incidences in the previous 12 months and associated health-seeking behaviours. Telephone surveys of 1676 respondents across England were conducted in March 2021 and 1663 respondents in March 2022. Findings were compared with a face-to-face baseline survey of 2022 respondents from March 2020. Key demographics were representative of the population. Results In 2021, the proportion of respondents who reported an RTI (51%) significantly declined from 2020 (70%, P < 0.05), then returned to pre-pandemic rates in 2022 (67%). Respondents reported more proactive symptom management in both 2021 and 2022 from 2020: there were greater reports of seeking over-the-counter treatments (55%, 55% vs. 35%, P < 0.05) and use of alternative remedies (38%, 38% vs. 21%, P < 0.05). 2022 observed a reduction in those who reported consulting their GP for their most recent RTI (15%) compared to 2021 (25%, P < 0.05) and 2020 (23%), which was not accounted for through greater consultation rates with other healthcare services. Conclusions Public health bodies should consider how pandemic-related changes may have facilitated increased self-care for self-limiting infections such as RTIs. Resources and support must include safety-netting advice to safeguard against unintentional consequences of increased self-care.

Restricted health service utilization and subsequent positive self-care behavior during the early COVID-19 pandemic in China

“…Firstly, the multivariate results supported much of what we anticipated earlier: the presence of RHSU was positively associated with all four kinds of self-care behavior in this study, and these associations remained significant even after adjusting for individual, environmental, and risk-perceptive control variables. Similar to the results of studies before (like medical services supply decline) and after the outbreak of the COVID-19 pandemic, these researchers also observed the association between social inequalities, pandemic-related changes, and individual health behavior ( 41 – 43 ). For instance, when individuals have potential health risks (including reduced accessibility to healthcare or deterioration of health status), this may stimulate the self-care activities and behaviors that were aimed at preventing or reducing health risks and optimizing health and quality of life ( 22 , 44 ).…”

“…The present studies claimed that this digital divide created by digital technologies might widen social inequalities by alienating disadvantaged groups that do not have access to digital resources ( 55 , 56 ). Thus, we recommend that particular attention be paid to the older adult when future discussions on critical issues surrounding the promotion of online medical consultations include quality of care ( 57 ), communication and language barriers ( 58 ), and patient satisfaction ( 43 ) .…”

“…Despite this, both external and intrinsic risk factors need to be considered for personal characteristics, previous research highlighted that not everyone responds to health risks similarly and that risk perception alone does not explain health behavior ( 59 ). For instance, the self-care behavior of chronic disease patients is associated with a high perceived susceptibility to disorders; they may tend to avoid in-person visits to hospitals, clinics, and emergency departments for fear of exposure to potential COVID-19 ( 43 ). Likewise, older adults are more vulnerable to COVID-19 infection, have a worse prognosis after infection, and have a higher risk of getting one or more non-communicable diseases, so that they may experience heightened levels of instilled fear of COVID-19 exposure during in-person medical services ( 3 ).…”

Revealing the drivers of antibiotic resistance trends inStreptococcus pneumoniaeamidst the 2020 COVID-19 pandemic: Insights from mathematical modeling

“…These trends in antibiotic prescribing may largely be explained by reduced incidence of seasonal respiratory tract infections and reduced primary care consultations (Andrews et al, 2022; Homeniuk and Collins, 2021). On the other hand, the advent of telemedicine, pandemic-induced patient stress, and increased antibiotic demand may have partly offset prescription reductions due to decreased consultations and healthcare-seeking behavior (Hsu, 2020; Read et al, 2023). In a global analysis of antimicrobial sales, Khouja et al found that antibiotic consumption initially increased by approximately 7% in March 2020, prior to subsequent declines through to August 2020 (Khouja et al, 2022).…”

“…Containment measures also massively reduced circulation of common respiratory viruses, which are known to be associated with invasive bacterial disease (Domenech De Cellès et al, 2019; Smith and Opatowski, 2021). Second, the lockdown was associated with reductions in primary care consultations (Homeniuk and Collins, 2021; Read et al, 2023; Zhang et al, 2021) leading to a global decrease of antibiotic prescriptions (Högberg et al, 2021). In contrast, frequent antibiotic prescribing to COVID-19 outpatients may have exacerbated AMR (Clancy et al, 2020; Knight et al, 2021).…”