Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation

Abstract

Background The national shielding programme was introduced by UK Government at the beginning of the COVID-19 pandemic, with individuals identified as clinically extremely vulnerable (CEV) offered advice and support to stay at home and avoid all non-essential contact. This study aimed to explore the impact and responses of “shielding” on the health and wellbeing of CEV individuals in Southwest England during the first COVID-19 lockdown. Methods A two-stage mixed methods study, including a structured survey (7 August—23 October 2020) and semi-structured telephone interviews (26 August—30 September 2020) with a sample of individuals who had been identified as CEV and advised to “shield” by Bristol, North Somerset & South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG). Results The survey was completed by 203 people (57% female, 54% > 69 years, 94% White British, 64% retired) in Southwest England identified as CEV by BNSSG CCG. Thirteen survey respondents participated in follow-up interviews (53% female, 40% > 69 years, 100% White British, 61% retired). Receipt of ‘official’ communication from NHS England or General Practitioner (GP) was considered by participants as the legitimate start of shielding. 80% of survey responders felt they received all relevant advice needed to shield, yet interviewees criticised the timing of advice and often sought supplementary information. Shielding behaviours were nuanced, adapted to suit personal circumstances, and waned over time. Few interviewees received community support, although food boxes and informal social support were obtained by some. Worrying about COVID-19 was common for survey responders (90%). Since shielding had begun, physical and mental health reportedly worsened for 35% and 42% of survey responders respectively. 21% of survey responders scored ≥ 10 on the PHQ-9 questionnaire indicating possible depression and 15% scored ≥ 10 on the GAD-7 questionnaire indicating possible anxiety. Conclusions This research highlights the difficulties in providing generic messaging that is applicable and appropriate given the diversity of individuals identified as CEV and the importance of sharing tailored and timely advice to inform shielding decisions. Providing messages that reinforce self-determined action and assistance from support services could reduce the negative impact of shielding on mental health and feelings of social isolation.

Exploring the attitudes of solid organ transplant recipients towards COVID-19 shielding communications and the language of ‘clinically extremely vulnerable’: a qualitative study investigating lessons for the future

“…While existing work has explored the impact of the pandemic on the mental health and quality of life of SOT recipients 4 7-10 and other 'higher risk' groups, 3 5 6 few studies 2 3 have considered the impact of public health communications on such groups. Adding to research that suggests individuals found shielding advice 'impractical and restrictive', 2 this study emphasises the even more troubling feelings of fear, anxiety and 'terror' (P12) that BMJ Public Health shielding communications engendered among many SOT recipients. This has similarly been found among other 'CEV' groups.…”

“…Recognising the severity of the UK's shielding rules, several studies have explored the impact of shielding on the well-being and quality of life of individuals classified as CEV, [2][3][4][5][6] with some evidence to suggest that mental health worsened significantly as a result of shielding. 2 SOT recipients-the first group listed under the definition of CEV by the UK Department of Health and Social Care in March 2020 1 -are one group that has received specific attention, with several studies exploring the impact of the pandemic on the mental health and quality of life of those living with a transplant. 4 7-10 However, qualitative studies exploring the experiences of SOT recipients are lacking.…”

Accessing health information during the COVID-19 pandemic: the experience of NHS maternity service users

“…Pregnant women who were clinically vulnerable were advised to “shield” [ 9 ]. ‘Shielding’ was a term used by the UK Government to protect people who were at the highest risk of being hospitalised by COVID-19, they were advised not to leave their homes and within their home to minimise time spent with others and to avoid using shared spaces when others were present [ 10 ].…”

Parent-reported child’s close contact with non-household family members and their well-being during the COVID-19 pandemic: A cross-sectional survey

“…While parents were advised to ensure their children engaged in physical activity during the initial lockdown, the extent to which this occurred, and the impact of that initial period of isolation and inactivity is uncertain. Some parents and children may also have been very cautious about the risks associated with COVID-19, engaging in additional protective behaviours that were not explicitly recommended by the Government and which may have exerted an additional toll on well-being [ 17 , 18 ].…”