Guiding organisational decision-making about COVID-19 asymptomatic testing in workplaces: mixed-method study to inform an ethical framework

Abstract

Background Workplace programmes to test staff for asymptomatic COVID-19 infection have become common, but raise a number of ethical challenges. In this article, we report the findings of a consultation that informed the development of an ethical framework for organisational decision-making about such programmes. Methods We conducted a mixed-method consultation – a survey and semi-structured interviews during November–December 2020 in a UK case study organisation that had introduced asymptomatic testing for all staff working on-site in its buildings. Analysis of closed-ended survey data was conducted descriptively. An analysis approach based on the Framework Method was used for the open-ended survey responses and interview data. The analyses were then integrated to facilitate systematic analysis across themes. Inferences were based on the integrated findings and combined with other inputs (literature review, ethical analysis, legal and public health guidance, expert discussions) to develop an ethical framework. Results The consultation involved 61 staff members from the case study organisation (50 survey respondents and 11 interview participants). There was strong support for the asymptomatic testing programme: 90% of the survey respondents viewed it as helpful or very helpful. Open-ended survey responses and interviews gave insight into participants’ concerns, including those relating to goal drift, risk of false negatives, and potential negative impacts for household members and people whose roles lacked contractual and financial stability. Integration of the consultation findings and the other inputs identified the importance of a whole-system approach with appropriate support for the key control measure of isolation following positive tests. The need to build trust in the testing programme, for example through effective communication from leaders, was also emphasised. Conclusions The consultation, together with other inputs, informed an ethical framework intended to support employers. The framework may support organisational decision-making in areas ranging from design and operation of the programme through to choices about participation. The framework is likely to benefit from further consultation and refinement in new settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13993-1.

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

“…People described guilt because their isolation would prevent them from performing their usual roles, meaning they were letting people down by not fulfilling their obligations and were placing an additional burden on work colleagues and household members 26 51 66 68 69. Healthcare workers described their guilt in increasing the workload of already overworked colleagues when they needed to isolate 70–72.…”

“…The negative impact self-isolating had on mental health was described by others as a main barrier to self-isolation 25 57. People anticipated that self-isolation would negatively impact their mental health,35 51 and the unwillingness to self-isolate was exacerbated by people becoming ‘fed up’ with missing out on social interactions and other activities as the pandemic progressed 52…”

“…In addition, self-isolation created financial hardship that acted as a barrier to reporting positive test results, in order to avoid isolation and its financial consequences 23 66 77–82. These challenges were in large part ascribed to loss of income through loss of work or wages 25 51 52 56 75 77 83…”

“…I’m a carer for vulnerable adults and would be worried about them receiving care that I could not give if I was isolating (Survey). 51 …”

“…Unlike the safety concerns influencing uptake of COVID-19 vaccinations,90 the concerns around the consequences of self-isolating were centred around the financial, practical and mental health effects of isolating. The interruption of daily life due to isolation was not only inconvenient22 26 32 35 43 66 95 but also meant that obligations were not fulfilled, resulting in a transfer of the burden to family, friends and colleagues and creating feelings of guilt for the person isolating 26 51 66 68 69. Isolation sometimes meant loss of work or even loss of a job; for many, this was too high a price to pay to prevent transmission,25 51 75 77 83 85 echoing the impacts of the adverse socioeconomic effects of isolation that have made it a less acceptable non-pharmaceutical intervention across other pandemics 2 96…”