Behavioural barriers to COVID-19 testing in Australia: Two national surveys to identify barriers and estimate prevalence by health literacy level

Bonner, Carissa; Batcup, Carys; Ayre, Julie; Pickles, Kristen; Cvejic, Erin; Copp, Tessa; Cornell, Samuel; Dodd, Rachael H; Nickel, Brooke; McCaffery, Kirsten

doi:10.1101/2021.08.26.21262649

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…5 , 6 This study identified different top barriers to testing as in our previous Australia-wide survey in November 2020; although both observed concerns about the test being painful within the top five. 11 Conversely, we observed lower COVID-19 vaccine willingness in this study compared with national Australian estimates during similar time periods (53% vs. 68–73%), 5 , 6 although this rate was similar to a study of 199 people from NSW, Australia, who spoke a language other than English at home (58%), 27 and higher than a study of 516 Australian refugee and asylum seekers (28%). 27…”

Section: Discussionsupporting

confidence: 61%

“…Participants were asked “ If I get signs of COVID-19 in the next 4 weeks (cough, sore throat, fever), the following might stop me from getting tested ,” with response options adapted from our previous survey findings, 11 , 22 modified to suit the Greater Western Sydney context (e.g., including responses that highlight concerns about visa status). Participants who responded “ I will get tested no matter what ” and listed no barriers were coded as high intention to get tested.…”

Section: Methodsmentioning

confidence: 99%

“…5 , 6 Our survey in November 2020 highlighted that the most common barriers to testing included having symptoms but not believing it was COVID (e.g., hayfever) (15%), preferring to self-isolate (13%), feeling that symptoms were not severe enough (11%), and concern that the test was painful (10%). 11 …”

Section: Introductionmentioning

confidence: 99%

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COVID-19 Testing and Vaccine Willingness: Cross-Sectional Survey in a Culturally Diverse Community in Sydney, Australia

et al. 2022

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Objective: The current study examined patterns in COVID-19 testing and vaccination intentions across multiple language groups in Greater Western Sydney, Australia. Methods: Participants completed a cross-sectional survey available from March 21 to July 9, 2021 in Sydney, Australia. Surveys were available in English or translated (11 languages). Participants could complete surveys independently or with support from bilingual staff. Logistic regression models using poststratification weighted frequencies identified factors associated with testing and vaccination intentions. Results: Most of the 708 participants (88%, n =622) were not born in Australia; 31% reported that they did not speak English well or at all ( n =220); 70% had no tertiary qualifications ( n =497); and 41% had inadequate health literacy ( n =290). Half (53.0%) reported willingness to get a COVID-19 vaccine if recommended to them ( n =375); 18% were unwilling ( n =127), and the remainder unsure (29%, n =205). These proportions varied significantly by language group ( p <0.001). Participants were more likely to be unwilling/hesitant if they were female ( p =0.02) or did not use Australian commercial information sources ( p =0.01). Concerns about side effects (30.4%, n =102) and safety (23.9%, n =80), were key reported barriers to vaccination. Most participants reported high testing intention (77.2%, n =546), with differences observed across language groups ( p <0.001). The most frequently reported barrier to testing was concerns about infection at the clinic (26.1%) followed by concerns that testing was painful (25.3%). Conclusion: Different language groups have unique and specific needs to support uptake of COVID-19 testing and vaccination. Health services must work collaboratively with culturally and linguistically diverse communities to provide tailored support to encourage COVID-19 testing and vaccination.

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Section: Discussionsupporting

confidence: 61%

Section: Methodsmentioning

confidence: 99%

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COVID-19 Testing and Vaccine Willingness: Cross-Sectional Survey in a Culturally Diverse Community in Sydney, Australia

et al. 2022

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“…We recruited 1,526 Australian adults (430 men, 1064 women, 32 non-binary or not reported) for an online randomised study about COVID testing between October and November 2021 (www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382318 ) using methods we have detailed previously 6 . We collected self-reported vaccination status (unvaccinated, 1 dose or 2 doses) and three measures of COVID-19 testing behaviour.…”

Section: Methodsmentioning

confidence: 99%

Testing behaviour may bias observational studies of vaccine effectiveness

Glasziou

McCaffery

Cvejic

et al. 2022

Preprint

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Background Recent observational studies have suggested that vaccines for the omicron variant of SARS-Cov2 may have little or no effect in preventing infection. However, the observed effects may be confounded by patient factors and preventive behaviours or vaccine-related differences in testing behaviour. To assess the potential degree of confounding, we aimed to estimate differences in testing behaviour between unvaccinated and vaccinated populations. Methods We recruited 1,526 Australian adults for an online randomised study about COVID testing between October and November 2021, and collected self-reported vaccination status and three measures of COVID-19 testing behaviour. We examined the association between testing intentions and vaccination status in the cross-sectional baseline data of this trial. Results Of the 1,526 participants (mean age 31 years): 22% had a COVID-19 test in the past month and 61% ever; 17% were unvaccinated, 11% were partially vaccinated (1 dose), 71% were fully vaccinated (2+ doses). Fully vaccinated participants were twice as likely to report positive COVID testing intentions than those who were unvaccinated (p<.001). Partially vaccinated participants had less positive intentions than those fully vaccinated (p<.001) but higher intentions than those who were unvaccinated (p=.002). Discussion For all three measures vaccination predicted greater COVID testing intentions. If the unvaccinated tested at half the rate of the vaccinated, a true vaccine effectiveness of 30% could appear to be a negative observed vaccine effectiveness of -40%. Assessing vaccine effectiveness should use methods to account for differential testing behaviours. Test negative designs are currently the preferred option, but its assumptions should be more thoroughly examined.

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“…about COVID-19 testing between October and November 2021 (www.anzctr.org.au/Trial/Registration/TrialReview. aspx?id=382318) using methods we have detailed previously (6,7). We collected self-reported vaccination status (unvaccinated, one dose, or two doses) and three measures of COVID-19 testing behaviour: self-reported testing in past month or ever and intention to test if they woke with a sore throat.…”

mentioning

confidence: 99%

Testing behaviour may bias observational studies of vaccine effectiveness

Glasziou

McCaffery

Cvejic

et al. 2022

Official Journal of the Association of Medical Microbiology and

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BACKGROUND: Recent observational studies suggest that vaccines may have little effect in preventing infection with the Omicron variant of severe acute respiratory syndrome coronavirus 2. However, the observed effects may be confounded by patient factors, preventive behaviours, or differences in testing behaviour. To assess potential confounding, we examined differences in testing behaviour between unvaccinated and vaccinated populations. METHODS: We recruited 1,526 Australian adults for an online randomized study about coronavirus disease 2019 (COVID-19) testing in late 2021, collecting self-reported vaccination status and three measures of COVID-19 testing behaviour: testing in past month or ever and test intention if they woke with a sore throat. We examined the association between testing intentions and vaccination status in the trial’s baseline data. RESULTS: Of the 1,526 participants (mean age 31 y), 22% had a COVID-19 test in the past month and 61% ever; 17% were unvaccinated, 11% were partially vaccinated (one dose), and 71% were fully vaccinated (two or more doses). Fully vaccinated participants were twice as likely as those who were unvaccinated (relative risk [RR] 2.2, 95% CI 1.8 to 2.8, p < 0.001) to report positive COVID testing intentions. Partially vaccinated participants had less positive intentions than fully vaccinated participants (RR 0.68, 95% CI 0.52 to 0.89, p < 0.001) but higher intentions than unvaccinated participants (RR 1.5, 95% CI 1.4 to 1.6, p = 0.002). DISCUSSION: Vaccination predicted greater COVID-19 testing intentions and would substantially bias observed vaccine effectiveness. To account for differential testing behaviours, test-negative designs are currently the preferred option, but their assumptions need more thorough examination.

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Behavioural barriers to COVID-19 testing in Australia: Two national surveys to identify barriers and estimate prevalence by health literacy level

Cited by 6 publications

References 17 publications

COVID-19 Testing and Vaccine Willingness: Cross-Sectional Survey in a Culturally Diverse Community in Sydney, Australia

COVID-19 Testing and Vaccine Willingness: Cross-Sectional Survey in a Culturally Diverse Community in Sydney, Australia

Testing behaviour may bias observational studies of vaccine effectiveness

Testing behaviour may bias observational studies of vaccine effectiveness

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