Public health information on COVID-19 for international travellers: lessons learned from a mixed-method evaluation

Abstract

Objectives In the containment phase of the response to the COVID-19 outbreak, Public Health England (PHE) delivered advice to travellers arriving at major UK ports. We aimed to rapidly evaluate the impact and effectiveness of these communication materials for passengers in the early stages of the pandemic. Study design Mixed-methods evaluation. Methods A cross-sectional survey and follow-up interviews with passengers arriving at London Heathrow Airport on scheduled flights from China and Singapore. The survey assessed passengers’ knowledge of symptoms, actions to take and attitudes towards PHE COVID-19 public health information; interviews explored their views of official public health information and self-isolation. Results 121 passengers participated in the survey and 15 in follow-up interviews. 83% of surveyed passengers correctly identified all three COVID-19 associated symptoms listed in PHE information at that time. Most could identify the recommended actions and found the advice understandable and trustworthy. Interviews revealed that passengers shared concerns about the lack of wider official action, and that passengers’ knowledge had been acquired elsewhere as much from PHE. Respondents also noted their own agency in choosing to self-isolate, partially as a self-protective measure. Conclusion PHE COVID-19 public health information was perceived as clear and acceptable, but we found that passengers acquired knowledge from various sources and they saw the provision of information alone on arrival as an insufficient official response. Our study provides fresh insights into the importance of taking greater account of diverse information sources and of the need for public assurance in creating public health information materials to address global health threats.

Learning about COVID-19 across borders: Public health information and adherence among international travellers to the UK

“…Even though COVID-19 related posters and leaflet stands had been set up at LHR, 12 participants had no recollection of seeing such posters or leaflets at all. Direct observation by our research team verified that the visibility of these information sources was very limited due to print size, colour, and placement 6 . Two participants recalled seeing hand sanitisers placed at the airport.…”

“…Accordingly, these participants had concerns about the vagueness of official advice and expressed preference to adopt precautionary measures drawing on prior knowledge derived from their countries of origin and with sociocultural resources, rather than with officially designated processes in the UK. Although there were no significant differences in participants' awareness and knowledge about COVID-19 symptoms and self-protection measures 6 , compared with other travellers, participants who were visitors or temporary residents had willingly adopted additional preventive measures that were not required according to UK official guidance at the time, to minimise their risk of exposure and transmission, and maintained such caution after their arrival. Such measures might have helped to reduce infection and transmission risks; however, longer stay visitors may have faced other adverse impacts as the pandemic continued due to their limited integration into local structures for practical, social, and emotional support, as well as difficulties in accessing health care.…”

“…Arriving from countries that had already experienced severe outbreaks, these travellers had acquired knowledge from the places where travel originated and adopted additional precautionary measures that went beyond local (UK) recommendations. Since the COVID-19 situation was unclear in the UK at that time, arrival ports had not instituted control measures, leading many arriving passengers to question the seriousness of the UK government's response to the pandemic 6 . The explicit public health information they received was less comprehensive than, and in some areas contradicted, official responses in the countries where travel originated.…”

“…The survey (n=121) collected information regarding knowledge of COVID-19 symptoms and help-seeking behaviours, views on public health advice provided by PHE, and participants' demographic information 6 . Respondents indicated willingness to be interviewed by recording their contact details on the questionnaire and consenting to participate when contacted on arrival; 15 of these respondents subsequently participated in semi-structured interviews.…”

“…Historical evidence on international passengers' views on, and compliance with, official advice and mitigation measures can provide valuable evidence to inform policy on the presentation of public health information to facilitate safer international travel. Our previous evaluation of the official advice on COVID-19 provided to international travellers reported on the impact and effectiveness of these communication materials in the early stage of the pandemic 6 . Drawing on qualitative data collected prior to the implementation of travel restrictions, this paper presents findings on individual assessment of risk, decision making, and adherence practices among travellers arriving into the UK by air who were confronted with potentially unfamiliar public health information.…”