Perspectives on COVID-19 testing policies and practices: a qualitative study with scientific advisors and NHS health care workers in England

Abstract

Background As COVID-19 death rates have risen and health-care systems have experienced increased demand, national testing strategies have come under scrutiny. Utilising qualitative interview data from a larger COVID-19 study, this paper provides insights into influences on and the enactment of national COVID-19 testing strategies for health care workers (HCWs) in English NHS settings during wave one of the COVID-19 pandemic (March–August 2020). Through the findings we aim to inform learning about COVID-19 testing policies and practices; and to inform future pandemic diagnostic preparedness. Methods A remote qualitative, semi-structured longitudinal interview method was employed with a purposive snowball sample of senior scientific advisors to the UK Government on COVID-19, and HCWs employed in NHS primary and secondary health care settings in England. Twenty-four interviews from 13 participants were selected from the larger project dataset using a key term search, as not all of the transcripts contained references to testing. Framework analysis was informed by the non-adoption, abandonment, scale-up, spread, and sustainability of patient-facing health and care technologies implementation framework (NASSS) and by normalisation process theory (NPT). Results Our account highlights tensions between the communication and implementation of national testing developments; scientific advisor and HCW perceptions about infectiousness; and uncertainties about the responsibility for testing and its implications at the local level. Conclusions Consideration must be given to the implications of mass NHS staff testing, including the accuracy of information communicated to HCWs; how HCWs interpret, manage, and act on testing guidance; and the influence these have on health care organisations and services.

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

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“…To conduct ethical analysis, we reviewed existing theories, principles and frameworks in relevant areas, with attention to the potential ethical challenges relevant to COVID-19 testing programmes and infectious diseases outbreaks (e.g. [ 32 , 54 , 56 , 58 – 62 , 73 ]). We also examined applicable legal and regulatory requirements related to testing and information governance (e.g.…”

The hidden burden of medical testing: public views and experiences of COVID-19 testing as a social and ethical process

“…While the economic burden of testing in terms of the potential costs of isolation has been widely discussed [ 74 – 76 ], neither the social costs of testing, nor the everyday emotional and cognitive ‘work’ of ethical reasoning and decision making are widely acknowledged. This is despite social and ethical issues being at the forefront of the testing experience for members of the public [ 4 , 9 , 42 ]. We therefore argue that the burden of testing needs to be understood as practical, economic and ethical and that navigating the ethics of COVID-19 testing can be considered a hidden form of public health and epidemic response work [ 50 , 51 ].…”

“…Social solidarity and a sense of civic responsibility were identified as important motivators to seek testing. Multiple studies also revealed barriers to testing uptake, including logistical issues [5][6][7][8][9], questions of accessibility [5,6], the physical discomfort associated with collecting a sample [10][11][12][13], economic pressures and anxieties [6,10,14,15], and symptom identification [5,6,[15][16][17][18][19][20]. Lack of trust in government bodies to deliver and manage testing was identified as a key barrier to testing in several studies [18,21], a finding that has been repeated in recent research on the role of governmental and interpersonal trust in vaccine uptake [22].…”

Challenges to evidence-informed decision-making in the context of pandemics: qualitative study of COVID-19 policy advisor perspectives

“…In the context of pandemics, rapidly evolving research environments, as well as the at times contentious sociopolitical context in which public health policy decisions must be made, create unique challenges for EIDM processes 5 6. Recent research and discussion specific to COVID-19 pandemic decision-making highlight concerns associated with the timing of response decisions, confusion and missed opportunities regarding levels of government responsible for and involved in decision-making, capacity to respond, communication around COVID-19-related guidance, and the use of discourse among authority figures to justify singular COVID-19 response options without attention to alternative policies 7–10. However, this research has fallen short of exploring specific challenges to EIDM as it relates to assessing, interpreting and translating evidence and advising pandemic decision-making from the perspective of those providing evidence.…”