Perceptions on undertaking regular asymptomatic self-testing for COVID-19 using lateral flow tests: A qualitative study of university students and staff

Abstract

BackgroundThere has been an increased interest from governments in implementing mass testing for COVID-19 of asymptomatic individuals using Lateral Flow Tests (LFTs). Successful implementation of such programmes depends on several factors, including feasibility, acceptability and how people act on test results. There is a paucity of studies examining these issues.ObjectiveWe aimed to examine experiences of university students and staff with experience of regular asymptomatic self-testing using LFTs, and their subsequent behaviours.MethodsWe invited people who were participating in a ‘weekly testing’ feasibility study. We conducted semi-structured remote interviews between December 2020 and January 2021. Additional qualitative data from a survey were also analysed. Data were analysed thematically.ResultsWe interviewed 18 and surveyed 214 participants. Participants were motivated to regularly self-test as they wanted to know whether or not they were infected with SARS-CoV-2. Most reported that a negative test result did not change their behaviour but it did provide them with reassurance to engage with permitted activities. In contrast, some participants reported making decisions about visiting other people when they would not have done so otherwise, because they felt reassured by a negative test result. Participants valued the test training but some participants still doubted their ability to carry out the test. Participants were concerned about safety of attending test sites with lots of people and reported home testing was most convenient.ConclusionsIf governments want to increase uptake of LFT use, clear messages highlighting the benefits of regular testing for family, friends and society in identifying asymptomatic cases are needed. This should be coupled with transparent communication about accuracy of LFTs and how to act on either a positive or negative result. Concerns about safety, convenience of testing, and ability to do tests need to be addressed to ensure successful scaling up asymptomatic testing.

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

“…Elsewhere, an interview study of UK police officers (n = 18) in May and June 2020 found that participants expected testing to help 'combat some of the fear and anxiety generated from working with the virus in close quarters on a day to day basis' [40] (p. 8) at a time when testing was not widely available in the community. University-based studies reported similar results [23,38]. For example, in a study of students in the UK in October 2020, participants reported lower anxiety and perceptions of being safer and better supported by the university [23,38].…”

“…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 ].…”

“…University-based studies reported similar results [23,38]. For example, in a study of students in the UK in October 2020, participants reported lower anxiety and perceptions of being safer and better supported by the university [23,38]. Just one study, a survey of pregnant women in a US delivery unit in May 2020 (n = 560), contradicted these findings by reporting very low levels of reassurance post-testing [34].…”

“…Social Solidarity, Peer-Pressure, and Stigma Social pressure (e.g., relating to the expected reactions of employers, friends, and family to an individual's decision to seek testing or test result) was a sub-focus of 14 studies in this review [23,24,26,27,32,33,38,40,45,46,48,54,67]. Six studies focused on negative pressure from employers and peers [38,40,45,46] or stigma [54,67] as barriers to testing. Negative pressure in institutions included dismissive attitudes towards COVID-19 transmission and pressures from management and colleagues not to seek out testing.…”

“…In Malawi, a study of the general population in May 2020 (n = 4641) found that 81% of survey respondents expected to be treated badly if they tested positive for COVID-19 [54]. Negative peer pressure was also a recurrent theme in studies involving student participants, since students are keenly aware that a positive test result will require peers (and often members of a shared household) to self-isolate [27,38]. Consistent with the above findings, a range of studies found that endorsements from and/or solidarity with peers, families, and supportive institutional cultures encourage testing [23,24,26,32,33].…”