Barriers to and strategies to address COVID-19 testing hesitancy: a rapid scoping review

Abstract

Background Testing is a foundational component of any COVID-19 management strategy; however, emerging evidence suggests that barriers and hesitancy to COVID-19 testing may affect uptake or participation and often these are multiple and intersecting factors that may vary across population groups. To this end, Health Canada’s COVID-19 Testing and Screening Expert Advisory Panel commissioned this rapid review in January 2021 to explore the available evidence in this area. The aim of this rapid review was to identify barriers to COVID-19 testing and strategies used to mitigate these barriers. Methods Searches (completed January 8, 2021) were conducted in MEDLINE, Scopus, medRxiv/bioRxiv, Cochrane and online grey literature sources to identify publications that described barriers and strategies related to COVID-19 testing. Results From 1294 academic and 97 grey literature search results, 31 academic and 31 grey literature sources were included. Data were extracted from the relevant papers. The most cited barriers were cost of testing; low health literacy; low trust in the healthcare system; availability and accessibility of testing sites; and stigma and consequences of testing positive. Strategies to mitigate barriers to COVID-19 testing included: free testing; promoting awareness of importance to testing; presenting various testing options and types of testing centres (i.e., drive-thru, walk-up, home testing); providing transportation to testing centres; and offering support for self-isolation (e.g., salary support or housing). Conclusion Various barriers to COVID-19 testing and strategies for mitigating these barriers were identified. Further research to test the efficacy of these strategies is needed to better support testing for COVID-19 by addressing testing hesitancy as part of the broader COVID-19 public health response.

Community voices on factors influencing COVID-19 concerns and health decisions among racial and ethnic minorities in the school setting

“…Factors related to testing and vaccine hesitancy in our sample were generally consistent with findings from other studies. For example, a scoping review of testing hesitancy also identified consequences of testing among the common barriers to testing in five other studies, though concerns about reliability of tests were not reported ( 41 ). Similar to other qualitative studies of diverse populations [e.g., ( 42 – 44 )], numerous participants who expressed hesitation about the COVID-19 vaccine reported concerns about its safety and effectiveness.…”

Community-based SARS-CoV-2 testing in low-income neighbourhoods in Rotterdam: Results from a pilot study

“…Turnout in location 3 was higher (11.4%) than in locations 1 (1.7%) and 2 (1.3%), likely due to the longer pilot period and the higher number of test facilities. Although our study shows that testing uptake can be increased by facilitating access to testing, there are many other factors that influence testing motivation and testing uptake [ 30 , 31 ]. Studies in several other countries showed associations between educational level or ethnicity and low testing uptake [ 16 , 32 ].…”

Between-Occupation Differences in Work-Related COVID-19 Mitigation Strategies over Time: Analysis of the Virus Watch Cohort in England and Wales

“…These findings indicate occupational inequalities that add to emerging evidence around sociodemographic inequalities in the implementation and uptake of mass testing programmes(35). Clear communication and support around testing at the employer and government level is likely to be crucial for future mass testing programmes, as unclear recommendations and fears around income loss or disruption to work may reduce workers’ engagement with testing(35,36). Workers’ personal usage of LFT devices was not investigated in this survey, but other behavioural surveys suggest low general population usage of LFTs in the UK (37).…”