Engagement With Daily Testing Instead of Self-Isolating in Contacts of Confirmed Cases of SARS-CoV-2: A Qualitative Analysis

Abstract

Introduction: In December 2020 and January 2021 Public Health England (PHE) with NHS Test and Trace conducted a study to explore the feasibility and acceptability of daily testing as an alternative to self-isolation following close contact with a confirmed COVID-19 case. This qualitative paper aims to identify factors influencing uptake among those offered daily testing, and the subsequent impact on behaviour.Methods: We conducted in-depth interviews with 52 participants who had taken part in the feasibility study. Participants were asked about their experiences of daily testing or self-isolating, their reasons for choosing to test or isolate, and their behaviour during the study period. Data were analysed using inductive thematic analysis.Results: Results are presented under two main headings: (1) factors influencing acceptance of testing and (2) impact of test results. Participants appeared highly motivated to engage in behaviours that would protect others from the virus. Factors influencing the decision to accept testing included (1) needing to avoid self-isolation, (2) concerns about test sensitivity, and (3) perceived benefits of detecting infection. Participants who were taking tests reported: (1) positive consequences following confirmation of COVID status, (2) engaging in essential activities, (3) uncertainty, and (4) self-isolating whilst testing.Conclusions: This study has identified a range of factors that appear to influence the decision to engage in daily testing or to self-isolate following close contact with a positive case, many of which could be addressed by clear communications. Covid-19 infection rates and government restrictions influenced experiences, and so further research is needed to explore perceptions of daily testing and behaviour following close contact with a positive case among a wider range of individuals, in the context of lower rates of COVID-19, few government restrictions on general population behaviour and more widespread testing.

Knowledge, Attitudes, and Behavior Related to COVID-19 Testing: A Rapid Scoping Review

“…Such studies commonly used social media and internet-based convenience sampling methods to recruit participants. Eight studies [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ] targeted participants of pilot testing programs (e.g., a telehealth system for testing [ 21 ] or the introduction of mass asymptomatic testing on a university campus [ 23 ]). Other target populations included patients or users of a specific health service or clinic [ 21 , 28 , 29 ] or health-related online app [ 30 , 31 ]; age-based populations [ 32 ]; health workers [ 33 , 34 , 35 , 36 , 37 ]; students and/or staff based at universities [ 23 , 24 , 25 , 26 , 27 , 38 ]; employment groups, such as police officers or industry workers [ 39 , 40 ]; and groups deemed especially vulnerable to COVID-19, such as homeless populations [ 41 ], refugee populations [ 42 ], or pregnant women attending clinical settings [ 34 , 35 , 43 ].…”

“…Nevertheless, the majority of high-income countries represented in the review had established community-based PCR testing for symptomatic cases during this period but had not yet instituted widespread rapid lateral flow antigen testing. Lateral flow testing is less widely represented in the evidence base and is more likely to feature in articles and preprints based on more recently collected data [ 22 , 38 ]. The characteristics of all studies included in the review are summarized in Table 1 [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ...…”

“…Lateral flow testing is less widely represented in the evidence base and is more likely to feature in articles and preprints based on more recently collected data [ 22 , 38 ]. The characteristics of all studies included in the review are summarized in Table 1 [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 …”

“…Studies that explored facilitating factors included research on participants’ knowledge and awareness of testing types and how they work [ 36 , 44 ] and research on people’s identification and interpretation of COVID-19 symptoms, including how this affects test-seeking behavior [ 30 , 45 , 46 , 47 ]. Multiple studies in this research area gathered data on people’s self-reported motivations for undergoing or avoiding testing [ 22 , 23 , 24 , 26 , 27 , 29 , 30 , 32 , 35 , 37 , 38 , 40 , 41 , 42 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. Some of these studies sought to gather data on people’s trust in the government and/or medical systems in relation to COVID-19 testing [ 24 , 41 , 54 , 55 ] or piloted ways to improve people’s levels of trust in testing [ 42 ].…”

“…Several studies reported high rates of intention to self-isolate among their participants [38,60] and of self-reported adherence to guidelines to self-isolate in the home following the positive result of the participant [57] or another member of the household [51]. In contrast to these findings, studies that recorded people's self-reported behaviors on a day-to-day basis [22,31,45] and studies that compared people's intentions and words to their practices and actions [45] were more likely to report low levels of self-adherence to isolation and testing behaviors. In some cases, particular socio-demographic characteristics were found to be associated with non-adherence.…”