Abstract
Background
During the early “containment” phase of the COVID-19 response in England (January-March 2020), contact tracing was managed by Public Health England (PHE). Adherence to self-isolation during this phase and how people were making those decisions has not previously been determined. The aim of this study was to gain a better understanding of decisions around adherence to self-isolation during the first phase of the COVID-19 response in England.
Methods
A mixed-methods cross sectional study was conducted, including an online survey and qualitative interviews. The overall pattern of adherence was described as never leaving home, leaving home for lower-contact reasons and leaving home for higher-contact reasons. Fisher’s exact test was used to test associations between adherence and potentially predictive binary factors. Factors showing evidence of association overall were then considered in relation to the three aspects of adherence individually. Qualitative data were analysed using inductive thematic analysis.
Results
Of 250 respondents who were advised to self-isolate, 63% reported not leaving home at all during their isolation period, 20% reported leaving only for lower-contact activities (dog walking or exercise) and 16% reported leaving for higher-contact, and therefore higher-risk, reasons. Factors associated with adherence to never going out included: the belief that following isolation advice would save lives, experiencing COVID-19 symptoms, being advised to stay in their room, having help from outside and having regular contact by text message from PHE. Factors associated with non-adherence included being angry about the advice to isolate, being unable to get groceries delivered and concerns about losing touch with friends and family. Interviews highlighted that a sense of duty motivated people to adhere to isolation guidance and where people did leave their homes, these decisions were based on rational calculations of the risk of transmission – people would only leave their homes when they thought they were unlikely to come into contact with others.
Conclusions
Understanding adherence to isolation and associated reasoning during the early stages of the pandemic is essential to pandemic preparedness for future emerging infectious disease outbreaks. Individuals make complex decisions around adherence by calibrating transmission risks, therefore treating adherence as binary should be avoided.
Original language | English |
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Article number | 2074 |
Number of pages | 15 |
Journal | BMC Public Health |
Volume | 23 |
DOIs | |
Publication status | Published - 23 Oct 2023 |
Bibliographical note
Funding Information:L.Y. is an NIHR Senior Investigator and her research programme is partly supported by NIHR Applied Research Collaboration (ARC)-West, NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, and the NIHR Southampton Biomedical Research Centre (BRC).
Funding Information:
CR is supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections at the University of Liverpool in partnership with UKHSA in collaboration with the Liverpool School of Tropical Medicine and The University of Oxford, the NIHR HPRU in Gastrointestinal Infections at the University of Liverpool in partnership with UKHSA, in collaboration with the University of Warwick and the NIHR HPRU in Behavioural Science and Evaluation at the University of Bristol, in partnership with UKHSA. C.R. is based at UKHSA.
Funding Information:
LY is an NIHR Senior Investigator and her research programme is partly supported by NIHR Applied Research Collaboration (ARC)-West, NIHR Health Protection Research Unit (HPRU) for Behavioural Science and Evaluation, and the NIHR Southampton Biomedical Research Centre (BRC).
Funding Information:
This work was funded by UK Research and Innovation (UKRI)/Department of Health and Social Care (DHSC) COVID-19 Rapid Response Call 2 [MC_PC 19071] and supported by the National Institute of Health Research (NIHR) Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol, in partnership with UK Health Security Agency (UK HSA; previously Public Health England).
Funding Information:
The authors would like to express their gratitude to all the participants who shared their experiences of self-isolation. C.R., R.R., G.L., P.C., H.L., M.H., S.D., L.Y., R.A., and I.O. are supported by the NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at the University of Bristol in partnership with UK Health Security Agency (UK HSA). L.S., J.R. and R.A. are supported by the NIHR HPRU in Emergency Preparedness and Response at King’s College London in partnership with UK HSA. L.Y. is an NIHR Senior Investigator and her research programme is partly supported by NIHR Applied Research Collaboration (ARC)-West, NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, and the NIHR Southampton Biomedical Research Centre (BRC). C.R. is affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emerging and Zoonotic Infections at the University of Liverpool in partnership with UK HSA in collaboration with the Liverpool School of Tropical Medicine and The University of Oxford, the NIHR HPRU in Gastrointestinal Infections at the University of Liverpool in partnership with UK HSA, in collaboration with the University of Warwick and the NIHR HPRU in Behavioural Science and Evaluation at the University of Bristol, in partnership with UK HSA. C.R. is based at UK HSA. The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or UK HSA. The funders had no role in the design of the study, collection, analysis and interpretation of the data, or in writing the manuscript.
Publisher Copyright:
© 2023, BioMed Central Ltd., part of Springer Nature.
Keywords
- Adherence
- Behaviour
- COVID-19
- Self-isolation