How best do we engage the general population in testing for COVID-19?

Abstract

The UK Scientific Advisory Group for Emergencies (SAGE) emphasises the need for high levels of engagement with communities and individuals to ensure the effectiveness of any COVID-19 testing programme. A novel pilot health surveillance programme to assess the feasibility of weekly mass RT-LAMP testing for the SARS-CoV-2 virus using saliva samples collected at home was developed and piloted by the University of Southampton and Southampton City Council. Rapid qualitative evaluation was conducted to explore experiences of those who took part in the programme, of those who declined and of those in the educational and healthcare organisations involved in the pilot testing who were responsible for roll-out. This included 77 interviews and 20 focus groups with 223 staff, students, pupils and household members from four schools, one university, and one community healthcare NHS trust. Conversations revealed that high levels of communication, trust and convenience were necessary to ensure people’s engagement with the programme. This suggests community leaders and stakeholder organisations should be involved throughout programme development and implementation to optimise these features of the testing. Participants’ and stakeholders’ motivations, challenges and concerns need to be understood and these insights used to modify the programme in a continuous, real-time process to ensure and sustain engagement with testing over the extended period necessary.

The social media response to twice-weekly mass asymptomatic testing in England

“…Another barrier was concern about taking a lateral flow test, which included the concerns that tests were being used to collect personal data, the potential health risks from the tests, discomfort of testing, and perception that taking a test twice a week was not normal and concerns over how long this would last. This is in-line with previous research that has identified concerns about use of personal data and discomfort of swabbing as barriers to testing [7,18].…”

“…Lack of support for those self-isolating has also been identified as a barrier to testing in previous research [6,7], and therefore financial support should be provided to everyone who needs to self-isolate, in order to encourage uptake of testing [19].…”

“…In mass weekly testing in Southampton, high-levels of communication, trust and convenience resulted in improved engagement with testing. Those who did not get tested reported reasons such as mistrust over personal data, the potential loss of money due to a positive test, and the environmental impact of tests [7]. Additionally, in asymptomatic testing of students at the University of Nottingham, facilitators to getting tested included desire to control the virus and the experience of taking a test being quick, whereas barriers TWICE-WEEKLY TESTING 3 included guilt about the impact on others (e.g., others having to isolate) and the mental health impact of isolation [8].…”

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

“…Negative peer pressure was also a recurrent theme in studies involving student participants, since students are keenly aware that a positive test result will require peers (and often members of a shared household) to self-isolate [27,38]. Consistent with the above findings, a range of studies found that endorsements from and/or solidarity with peers, families, and supportive institutional cultures encourage testing [23,24,26,32,33]. This was especially true in institutional settings (e.g., schools and GP surgeries), where participants' decisions to engage in a pilot project were 'influenced by a pull on their sense of community' [24] (p. 9) and the feeling that they were 'in it together' [23] (p. 22) There is some ambiguity about the relative influence of negative and positive pressure in these studies, however, since participants were also reported to fear the stigma associated with a positive test result [24].…”

“…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.…”