Adherence to behaviours associated with the test, trace, and isolate system: An analysis using the Theoretical Domains Framework

Abstract

Background: The UK’s test, trace, and isolate system are key measures to reduce the impact and spread of the COVID-19. However, engagement with and adherence to guidance on testing, self-isolation, and providing details of contacts can be low and interventions are needed. This qualitative study aimed to identify the key factors affecting adherence to test, trace, and isolate behaviours using the Theoretical Domains Framework (TDF). Methods: We conducted six online focus groups between October 2020 and February 2021 with people living in Sheffield who came into close contact with others in work or social settings (N = 30). The focus groups explored capability, opportunity, and motivational barriers to adherence to test, trace, and isolate behaviours. Framework analysis was used to code the data into TDF domains. Results: There is a complex relationship between the factors affecting COVID-19 symptom identification, testing, and self-isolation. People who perceived significant barriers to testing and self-isolation were less likely to interpret potential symptoms as COVID-19, and perceiving barriers to self-isolation reduced the likelihood of requesting a test. Concerns about the negative consequences of self-isolation for themselves and others were common and also influenced willingness to pass on details of contacts. There was a lack of trust in the Test and Trace system, with people wanting further evidence of being at risk of infection. Conclusions: Communications and interventions to increase adherence to test, trace, and isolate strategies need to consider the interplay of these behaviours and their influences and target them collectively. Efforts to promote testing should focus on the range of barriers to self-isolation, especially increasing financial and practical support, and include new messaging to promote symptom identification.

Public perceptions and interactions with UK COVID-19 Test, Trace and Isolate policies, and implications for pandemic infectious disease modelling

“…Lack of trust has also been found in other UK studies, including in interviews conducted amongst members of the public in Sheffield, England from October 2020 -February 2021, with people wanting further evidence as to their risk of infection as close contacts asked to quarantine [5]. At the time of our interviews in July 2021 we did not find people wanting further evidence but rather making their own risk assessments.…”

“…Rapid lateral flow device (LFD) tests were freely available in pharmacies, some workplaces and via a government website throughout the period, and PCR tests were freely available for those with the specific symptoms and for contacts of identified cases. Pandemics are evolving situations, and the qualitative snapshot we have taken complements previous TTI policy-related work of March-April 2020 [2], TTI pilots of daily testing in December 2020 [4], Sheffield-specific interviews from October 2020 - February 2021 [5] and the CORSAIR surveys of June 2021 [6], and Office for National Statistics (ONS) surveys (e.g. [47]).…”

Public perceptions and interactions with UK COVID-19 Test, Trace and Isolate policies, and implications for pandemic infectious disease modelling

“…Lack of trust has also been found in other UK studies, including in interviews conducted amongst members of the public in Sheffield, England from October 2020 -February 2021, with people wanting further evidence as to their risk of infection as close contacts asked to quarantine. 8 At the time of our interviews in July 2021 we did not find people wanting further evidence but rather making their own risk assessments. Along with another study from the UK in from November-December 2020, we did find that individuals tended to be more inclined to test and isolate when experiencing symptoms 20 and people felt encouraged to test when they thought they had COVID-19.…”

“…Pandemics are evolving situations, and interviews conducted at a specific timepoint need to be viewed as 'snapshots' and as dependent on the specific context. Our research undertaken in summer 2021 complements learnings from other times points: research on public engagement with TTI in March-April 2020, 6 pilots of daily testing of contacts undertaken in December 2020, 7 Sheffield-specific interviews from October 2020 -February 2021 8 and the CORSAIR surveys of June 2021, 9 as well Office for National Statistics (ONS) surveys (e.g. August 2021 10 ).…”

Understanding adherence to self-isolation in the first phase of COVID-19 response

“…A growing body of evidence indicates variation in the extent to which people adhere to self-isolation guidance and what factors may influence adherence 5,6,7,8 . However, understanding adherence to self-isolation is limited by how adherence is measured.…”