Understanding adherence to self-isolation in the first phase of COVID-19 response

Abstract

Objective: To gain a better understanding of decisions around adherence to self-isolation advice during the first phase of the COVID-19 response in England. Design: A mixed-methods cross sectional study. Setting: England Participants COVID-19 cases and contacts who were contacted by Public Health England (PHE) during the first phase of the response in England (January-March 2020). Results: Of 250 respondents who were advised to self-isolate, 63% reported not leaving home at all during their isolation period, 20% reported leaving only for lower risk activities (dog walking or exercise) and 16% reported leaving for potentially higher risk, reasons (shopping, medical appointments, childcare, meeting family or friends). Factors associated with adherence to never going out included: the belief that following isolation advice would save lives, experiencing COVID-19 symptoms, being advised to stay in their room (rather than just inside), having help from outside and having regular contact by text message from PHE. Factors associated with non-adherence included being angry about the advice to isolate, being unable to get groceries delivered and concerns about losing touch with friends and family. Interviews highlighted that a sense of duty motivated people to adhere to isolation guidance and where people did leave their homes, these decisions were based on rational calculations of the risk of transmission; people would only leave their homes when they thought they were unlikely to come into contact with others. Conclusions: Measures of adherence should be nuanced to allow for the adaptations people make to their behaviour during isolation. Understanding adherence to isolation and associated reasoning during the early stages of the pandemic is an essential part of pandemic preparedness for future emerging infectious diseases.

Measuring and increasing rates of self-isolation in the context of infectious diseases: A systematic review with narrative synthesis

“…[41] One study reported two prevalence estimates. [76] Twenty prevalence estimates were at very high risk of bias, [21, 23, 24, 28, 29, 31–37, 40, 47, 69–72, 74, 76–78] 14 were at high risk, [21, 22, 27, 38, 44–46, 73, 79, 81–83, 85] ten had some concerns, [25, 26, 30, 39, 42, 43, 48–68, 80, 84] and one was at low risk. [75] Full details for each study are reported in Supplement S6.…”

“…Twenty-five studies investigated factors associated with adherence to self-isolation. [23, 29, 30, 34–43, 45–68, 73, 75–78, 81–83] Of these, 24 were assessed using the ROBINS-E. Analyses of associations from seven studies were at very high risk of bias, [30, 34, 37, 38, 73, 77, 78, 83], 15 were at high risk of bias, [23, 29, 35, 36, 40–43, 47–68, 75, 76, 81, 82] and two had some concerns (Supplement S6).…”

“…[23, 29, 30, 34–43, 45–68, 73, 75–78, 81–83] Of these, 24 were assessed using the ROBINS-E. Analyses of associations from seven studies were at very high risk of bias, [30, 34, 37, 38, 73, 77, 78, 83], 15 were at high risk of bias, [23, 29, 35, 36, 40–43, 47–68, 75, 76, 81, 82] and two had some concerns (Supplement S6). [39, 45] One study was assessed using the ROBINS-I and was rated as very high risk of bias.…”

“…Five analyses found an association between adherence and older age (one at some concerns of bias), [34, 39, 41, 77, 78] three found an association with younger age, [29, 48–61, 83] and 12 found no evidence for an association. [23, 29, 30, 35, 36, 42, 43, 62–68, 73, 81, 82]…”

“…There was good evidence that adherence to self-isolation was associated with having COVID-19 symptoms, [37, 38, 62–67, 73, 83] and testing positive for COVID-19 (vs being a contact, testing negative; association found by one analysis at some concerns of bias; Table 4). [39, 46, 48–61] Taken together, there was some evidence that practical support may be associated with adherence to self-isolation (Table 4).…”