Addressing Behavioral Barriers to COVID-19 Testing With Health Literacy-Sensitive eHealth Interventions: Results From 2 National Surveys and 2 Randomized Experiments.

BACKGROUND: Polymerase chain reaction (PCR) testing for COVID-19 was crucial in Australia's prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact with cases, travel, and certain professions. However, several months into the pandemic, half of Australians were still not getting tested for respiratory symptoms, and little was known about the drivers of and barriers to COVID-19 PCR testing as a novel behavior at that time. OBJECTIVE: We aimed to identify and address COVID-19 testing barriers, and test the effectiveness of multiple eHealth interventions on knowledge for people with varying health literacy levels. METHODS: The intervention was developed in 4 phases. Phase 1 was a national survey conducted in June 2020 (n=1369), in which testing barriers were coded using the capability-opportunity-motivation-behavior framework. Phase 2 was a national survey conducted in November 2020 (n=2034) to estimate the prevalence of testing barriers and health literacy disparities. Phase 3 was a randomized experiment testing health literacy-sensitive written information for a wide range of barriers between February and March 2021 (n=1314), in which participants chose their top 3 barriers to testing to view a tailored intervention. Phase 4 was a randomized experiment testing 2 audio-visual interventions addressing common testing barriers for people with lower health literacy in November 2021, targeting young adults as a key group endorsing misinformation (n=1527). RESULTS: In phase 1, barriers were identified in all 3 categories: capability (eg, understanding which symptoms to test for), opportunity (eg, not being able to access a PCR test), and motivation (eg, not believing the symptoms are those of COVID-19). Phase 2 identified knowledge gaps for people with lower versus higher health literacy. Phase 3 found no differences between the intervention (health literacy-sensitive text for top 3 barriers) and control groups. Phase 4 showed that a fact-based animation or a TikTok-style video presenting the same facts in a humorous style increased knowledge about COVID-19 testing compared with government information. However, no differences were found for COVID-19 testing intentions. CONCLUSIONS: This study identified a wide range of barriers to a novel testing behavior, PCR testing for COVID-19. These barriers were prevalent even in a health system where COVID-19 testing was free and widely available. We showed that key capability barriers, such as knowledge gaps, can be improved with simple videos targeting people with lower health literacy. Additional behavior change strategies are required to address motivational issues to support testing uptake. Future research will explore health literacy strategies in the current context of self-administered rapid antigen tests. The findings may inform planning for future COVID-19 variant outbreaks and new public health emergencies where novel testing behaviors are required. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12621000876897, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382318 ; Australian New Zealand Clinical Trials Registry ACTRN12620001355965, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380916&isReview=true.

Uptake of the Australian Heart Health Check before and after the COVID-19 pandemic outbreak

IN AUSTRALIA, cardiovascular disease (CVD) is the leading cause of death and accounts for 9% of total disease expenditure ($10.4 billion).1,2 If current Australian guidelines were fully implemented, using absolute CVD risk assessment to guide the prescribing of medication for high-risk patients, an estimated $5.4 billion would be saved per year.3'4 MedicineInsight data suggest that only 17% of Australian patients aged 45-74 years attending general practice have the required risk factors recorded to enable an absolute CVD risk assessment, although this may not be representative and is limited to data recorded in specified fields.5 Health assessment Medicare Benefits Schedule (MBS) items are time-based consultation items targeted towards the prevention and management of chronic diseases that include taking a patient's history, physical measurements and providing management advice about medication and lifestyle change (Table 1). To increase the uptake of CVD primary prevention guidelines, a dedicated 'Heart Health Check' MBS item (699) was introduced on 1 April 2019, under which medical practitioners could claim a fee ($85.60) for a dedicated CVD risk consultation that lasts at least 20 minutes.6 Item 699 has a specific focus on identifying CVD risk factors and initiating CVD risk management strategies for high-risk patients. From April 2020 there have been multiple changes to the delivery of primary health services in response to the COVID-19 pandemic.7 Despite effective COVID-19 control measures in Australia, national general practitioner (GP) surveys conducted in 2020 and 2021 indicated a high impact of and concern about the pandemic, including the safety of staff, the rapid move to telehealth, reduced income due to a drop in patient presentation, increased workload during the vaccination rollout and inadequate government support, including a lack of safety equipment.8'9 In addition, the National Heart Foundation of Australia has estimated that 27,000 fewer Heart Health Checks were conducted due to COVID-19.10 As such, this study aimed to explore the uptake of Item 699 since its introduction and changes in existing health assessment item claims. Methods Study overview Publicly available databases were used for MBS item claims and population estimates.11 Data were available by age range, sex and state or territory. Because it was not possible to determine race or ethnicity, data for all adults aged >35 years were included in accordance with national guideline recommendations at the time of data collection for absolute CVD risk assessment in Aboriginal and Torres Strait Islander people aged >35 years and all other adults aged >45 years.3 MBS claims data for health assessment Items 699, 701, 703, 705, 707 and 715 were downloaded and compared between three time periods: the 12-month period before the introduction of Item 699 (1 April 2018-31 March 2019);the 12-month period after the introduction of Item 699 (1 April 2019-31 March 2020);and the 12-month period with COVID-19 outbreaks affecting the delivery of health services through primary care (1 April 2020-31 March 2021).12 Subsequently, health assessment item claims were assessed by age, sex and state/territory for the 24-month period after Item 699 was introduced (1 April 2019-31 March 2021).

COVID-19 messages targeting young people on social media: content analysis of Australian health authority posts.

Health authorities utilized social media during the COVID-19 pandemic to disseminate critical and timely health messages, specifically targeting priority groups such as young people. To understand how social media was used for this purpose, we investigated the content of COVID-19-related social media posts targeting young people (16-29 years old) shared by Australian health departments. Posts targeting young people with COVID-19 information were extracted from all eight Australian State and Territory health department Facebook, Instagram and TikTok accounts over 1 month of the Delta outbreak (September 2021) and analysed thematically. In total, 238 posts targeting young people were identified from 1059 COVID-19 posts extracted. All eight health departments used Facebook, five used Instagram and only one used TikTok. The majority of posts implicitly targeted young people; only 14.7% explicitly mentioned age or 'young people'. All posts included accompanying visuals; 77% were still images like photos or illustrations whilst 23% were moving images like videos and GIFs. Communication techniques included calls to action (63% of posts), responsive communication (32% of posts) and positive emotional appeal (31% of posts). Social marketing techniques catering to young people were used to varying extents despite receiving higher levels of engagement; 45% featured emojis whilst only 16% used humour, 14% featured celebrities and 6% were memes. Priority groups like ethnic/cultural groups and chronic health/disability communities were rarely targeted in this communication. The findings indicate a lack of health communication on social media directed towards young people, highlighting an opportunity for increased use of platforms like TikTok and trends popular with young people online.

Implementing patient decision aids into general practice clinical decision support systems: Feasibility study in cardiovascular disease prevention.

Objective: Patient decision aids (DA) facilitate shared decision making, but implementation remains a challenge. This study tested the feasibility of integrating a cardiovascular disease (CVD) prevention DA into general practice software. Methods: We developed a desktop computer application (app) to auto-populate a CVD prevention DA from general practice medical records. 4 practices received monthly practice reports from July-Nov 2021, and 2 practices use the app with limited engagement. CVD risk assessment data and app use were monitored. Results: The proportion of eligible patients with complete CVD risk assessment data ranged from 59 to 94%. Monthly app use ranged from 0 to 285 sessions by 13 individual practice staff including GPs and nurses, with staff using the app an average of 67 sessions during the study period. High users in the 5-month study period continued to use the app for 10 months. Low use was attributed to reduced staff capacity during COVID-19 and technical issues. Conclusion: High users sustained interest in the app, but additional strategies are required for low users. The study will inform implementation plans for new guidelines. Innovation: This study showed it is feasible to integrate patient decision aids with Australian general practice software, despite the challenges of COVID-19 at the time of the study.

COVID-19 information sources in culturally diverse communities in Australia: Cross-sectional survey: Presenter(s): Julie Ayre, The University of Sydney, Australia

Culturally and linguistically diverse communities are a priority group that has been disproportionately affected by the pandemic. However, they have been largely excluded from Australian surveys that capture data about people's knowledge, attitudes, and experiences relating to COVID-19. This study sought to investigate preferred COVID-19 communication channels and information-seeking experiences within these communities. The cross-sectional survey was co-designed with Multicultural Health and bilingual staff, and translated into 11 languages. Participants were recruited in Sydney, Australia, from March 21 to July 9, 2021, with supporting bilingual staff. Linear regression models identified factors associated with difficulty finding easy-to-understand COVID-19 information. Across 708 participants (88% born overseas, 31% poor English proficiency), difficulty finding easy-to-understand COVID-19 information was rated 4.13 for English materials (95%CI: 3.85 to 4.41) and 4.36 for translated materials (95%CI: 4.07 to 4.66) (1 easy to 10 hard). Participants who were older (p<0.001), had low health literacy (Mean Difference (MD)=-1.43, 95%CI -2.03 to -0.82, p<0.001), or poor English proficiency (MD=-1.9, 95%CI-2.51 to -1.29, p<0.001) found it harder to find easy-to-understand English-language COVID-19 information. Those who had greater difficulty finding easy-to-understand translated COVID-19 information were younger (p=0.004), had poor English proficiency (MD=-1.61, 95%CI -2.29 to -0.9, p<0.001), university education (MD=0.77, 95%CI 0.00 to 1.53, p=0.05), and had spent longer living in Australia (p=0.001). They were more likely to rely on friends and family for COVID-19 information (p=0.02). There was significant variation in information-seeking experiences across language groups (p's<0.001). Easy-to-understand and accessible COVID-19 information is urgently needed and must meet the needs of people in culturally and linguistically diverse communities. The findings are highly applicable to other public health issues, highlighting the limitations of a one-size-fits-all approach to public health communication. Health services must work alongside these communities to tailor public health messages and leverage existing communication channels. [ABSTRACT FROM AUTHOR] Copyright of Patient Education & Counseling is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Uptake of the Australian Heart Health Check before and after the COVID-19 pandemic outbreak.

BACKGROUND AND OBJECTIVES: In 2019, a 'Heart Health Check' Medicare Benefit Schedule (MBS) item (699) was introduced to support cardiovascular risk assessment. This study sought to determine the uptake of Item 699 and changes to existing health assessment item claims, before and after the COVID­19 outbreak. METHOD: National MBS data for health assessment items were analysed for adults aged ≥35 years. RESULTS: Item 699 accounted for 9% of health assessment item claims since its introduction. Claims for pre-existing health assessment items were virtually unchanged (1% increase) after Item 699 was introduced. Overall, there were 68,967 fewer health assessment item claims (7% decrease) after the COVID-19 outbreak and Item 699 had the greatest decline in claims (27% reduction). DISCUSSION: Uptake of Item 699 accounted for 9% of health assessment item claims since its introduction. COVID-19 restrictions coincided with a decline in all health assessment item claims, particularly for Item 699.

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

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.

Collateral positives of COVID-19 for culturally and linguistically diverse communities in Western Sydney, Australia.

BACKGROUND: To investigate whether culturally and linguistically diverse (CALD) communities in Western Sydney have experienced any positive effects during the COVID-19 pandemic, and if so, what these were. METHODS: A cross-sectional survey with ten language groups was conducted from 21st March to 9th July 2021 in Sydney, Australia. Participants were recruited through bilingual multicultural health staff and health care interpreter service staff and answered a question, 'In your life, have you experienced any positive effects from the COVID-19 pandemic?' Differences were explored by demographic variables. Free-text responses were thematically coded using the Content Analysis method. RESULTS: 707 people completed the survey, aged 18 to >70, 49% males and 51% females. Only 161 (23%) of those surveyed reported any positive impacts. There were significant differences in the proportion of those who reported positives based on age (p = 0.004), gender (p = 0.013), language (p = 0.003), health literacy (p = 0.014), English language proficiency (p = 0.003), education (p = <0.001) and whether participants had children less than 18 years at home (p = 0.001). Content Analysis of open-ended responses showed that, of those that did report positives, the top themes were 'Family time' (44%), 'Improved self-care' (31%) and, 'Greater connection with others' (17%). DISCUSSION: Few surveyed participants reported finding any positives stemming from the COVID-19 pandemic. This finding is in stark contrast to related research in Australia with participants whose native language is English in which many more people experienced positives. The needs of people from CALD backgrounds must inform future responses to community crises to facilitate an equitable effect of any collateral positives that may arise.

Testing behaviour may bias observational studies of vaccine effectiveness.

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.

HISTORIQUE: Selon de récentes études observationnelles, les vaccins peuvent avoir peu d'effet sur la prévention de l'infection par le variant Omicron du coronavirus 2 du syndrome respiratoire aigu sévère. Cependant, les effets observés peuvent être biaisés par des facteurs liés aux patients, des comportements préventifs ou des différences de comportements liés aux tests. Pour évaluer les facteurs confusionnels potentiels, les auteurs ont examiné les différences de comportements liés aux tests entre les populations non vaccinées et vaccinées. MÉTHODOLOGIE: Les auteurs ont recruté 1 526 adultes australiens en vue d'une étude randomisée en ligne sur les tests de la maladie à coronavirus 2019 (COVID-19) à la fin de 2021, afin de colliger l'état vaccinal autodéclaré et trois mesures sur les comportements liés aux tests de la COVID-19 : test au cours du mois précédent ou jamais auparavant et intention de se soumettre à un test en cas de mal de gorge. Ils ont examiné l'association entre les intentions de se soumettre à un test et l'état vaccinal dans les données de référence de l'étude. RÉSULTATS: Sur les 1 526 participants (d'un âge moyen de 31 ans), 22 % avaient subi un test de COVID-19 au cours du mois précédent et 61 % n'en avaient jamais subi; 17 % n'étaient pas vaccinés, 11 % l'étaient partiellement (une dose) et 71 % l'étaient pleinement (au moins deux doses). Les participants pleinement vaccinés étaient deux fois plus susceptibles que ceux qui ne l'étaient pas (risque relatif [RR] 2,2, IC à 95 % 1,8 à 2,8, p < 0,001) de déclarer des intentions de se faire tester contre la COVID-19. Les participants partiellement vaccinés avaient des intentions moins positives que les participants pleinement vaccinés (RR 0,68, IC à 95 % 0,52 à 0,89, p < 0,001), mais plus élevées que ceux qui ne l'étaient pas du tout (RR 1,5, IC à 95 % 1,4 à 1,6, p = 0,002). DISCUSSION: La vaccination était prédictive de plus grandes intentions de subir un test de COVID-19 et établissait un biais important à l'égard de l'efficacité réelle des vaccins. Pour tenir compte des comportements différentiels vis-à-vis des tests, les méthodologies de tests négatifs constituent actuellement la solution privilégiée, mais cette hypothèse doit être approfondie.

COVID-19 Vaccine Misperceptions in a Community Sample of Adults Aged 18-49 Years in Australia.

Central to a successful population vaccination program is high uptake of vaccines. However, COVID-19 vaccine uptake may be impeded by beliefs based on misinformation. We sought to understand the prevalence and nature of misbeliefs about COVID-19 vaccines, and identify associated factors, shortly after commencement of Australia's national vaccine rollout. A cross-sectional survey was administered to unvaccinated young adults (n = 2050) in Australia aged 18-49 years (mean age 33 years), 13 July-21 August 2021. This sample was previously under-represented in COVID-19 research but shown to have less willingness to vaccinate. Two thirds of participants agreed with at least one misbelief item. Misperceptions about COVID-19 vaccines were found to be significantly associated with lower health literacy, less knowledge about vaccines, lower perceived personal risk of COVID-19, greater endorsement of conspiracy beliefs, and lower confidence and trust in government and scientific institutions. Misbeliefs were more common in participants with less educational attainment, in younger age groups, and in males, as per previous research. Understanding determinants and barriers to vaccination uptake, such as knowledge and beliefs based on misinformation, can help to shape effective public health communication and inform debunking efforts at this critical time and in the future.

Psychological, social and financial impacts of COVID-19 on culturally and linguistically diverse communities in Sydney, Australia.

OBJECTIVE: To explore the psychological, social and financial outcomes of COVID-19-and the sociodemographic predictors of those outcomes-among culturally and linguistically diverse communities in Sydney, Australia. DESIGN: Cross-sectional survey informed by the Framework for Culturally Competent Health Research conducted between March and July 2021. SETTING: Participants who primarily speak a language other than English at home were recruited from Greater Western Sydney, New South Wales. PARTICIPANTS: 708 community members (mean age: 45.4 years (range 18-91)). 88% (n=622) were born outside of Australia, 31% (n=220) did not speak English well or at all, and 41% (n=290) had inadequate health literacy. OUTCOME MEASURES: Thirteen items regarding COVID-19-related psychological, social and financial outcomes were adapted from validated scales, previous surveys or co-designed in partnership with Multicultural Health and interpreter service staff. Logistic regression models (using poststratification weighted frequencies) were used to identify sociodemographic predictors of outcomes. Surveys were available in English or translated (11 languages). RESULTS: In this analysis, conducted prior to the 2021 COVID-19 outbreak in Sydney, 25% of the sample reported feeling nervous or stressed most/all of the time and 22% felt lonely or alone most/all of the time. A quarter of participants reported negative impacts on their spousal relationships as a result of COVID-19 and most parents reported that their children were less active (64%), had more screen time (63%) and were finding school harder (45%). Mean financial burden was 2.9/5 (95% CI 2.8 to 2.9). Regression analyses consistently showed more negative outcomes for those with comorbidities and differences across language groups. CONCLUSION: Culturally and linguistically diverse communities experience significant psychological, social and financial impacts of COVID-19. A whole-of-government approach is needed to support rapid co-design of culturally safe support packages in response to COVID-19 and other national health emergencies, tailored appropriately to specific language groups and accounting for pre-existing health disparities.

Parent-level barriers to uptake of childhood vaccination: a global overview of systematic reviews.

INTRODUCTION: Understanding barriers to childhood vaccination is crucial to inform effective interventions for maximising uptake. Published systematic reviews include different primary studies, producing varying lists of barriers. To make sense of this diverse body of literature, a comprehensive level of summary and synthesis is necessary. This overview of systematic reviews maps all potential parent-level barriers to childhood vaccination identified in systematic reviews. It synthesises these into a conceptual framework to inform development of a vaccine barriers assessment tool. METHODS: We applied Joanna Briggs methodology, searching the Epistemonikos review database and reference lists of included reviews to June 2020. Systematic reviews of qualitative or quantitative data on parent-level barriers to routine vaccination in preschool-aged children were included. Reviews addressing influenza, reporting non-modifiable determinants or reporting barriers not relevant to parents were excluded. Where possible, we extracted review details, barrier descriptions and the number, setting and design of primary studies. Two authors independently screened search results and inductively coded barrier descriptions. RESULTS: We screened 464 papers, identifying 30 relevant reviews with minimal overlap. Fourteen reviews included qualitative and quantitative primary studies, seven included quantitative and seven included qualitative studies only. Two did not report included study designs. Two-thirds of reviews (n=20; 67%) only included primary studies from high-income countries. We extracted 573 barrier descriptions and inductively coded these into 64 unique barriers in six overarching categories: (1) Access, (2) Clinic or Health System Barriers, (3) Concerns and Beliefs, (4) Health Perceptions and Experiences, (5) Knowledge and Information and (6) Social or Family Influence. CONCLUSIONS: A global overview of systematic reviews of parent-level barriers to childhood vaccine uptake identified 64 barriers to inform development of a new comprehensive survey instrument. This instrument will assess both access and acceptance barriers to more accurately diagnose the reasons for under-vaccination in children in different settings.

COVID-19 challenges faced by general practitioners in Australia: a survey study conducted in March 2021.

Limited studies at the beginning of the COVID-19 pandemic found GPs have been negatively affected by increased workload, reduced income and major concerns about staff and patient safety. This study aimed to investigate the challenges of COVID-19 in general practice 1 year since it was declared a pandemic. A national cross-sectional online survey was conducted in March 2021 of a convenience sample of 295 Australian GPs attending an online educational webcast. Twenty-five multipart and free-text questions collected information regarding GPs' main COVID-19-related issues and concerns, including COVID-19 vaccines, useful sources of information, information needs and their perceived role as GPs in COVID-19 management. Descriptive statistics were calculated for all quantitative variables. Content analysis was used to analyse text data from open-ended questions. Of the 596 eligible attendees of the online educational webcast, 295 completed the survey (49.5% response rate). One year since COVID-19 was declared a pandemic, GPs still have concerns regarding patients ignoring prescreening and presenting with flu-like symptoms, the safety of their colleagues and family and catching COVID-19 themselves, as well as concerns about the effect of the pandemic on their patients and patients delaying essential care for non-COVID-19 conditions. More education and resources about vaccines was identified as the top information need, which will assist with what GPs' perceived to be their key roles in managing the COVID-19 pandemic, namely educating the public, correcting misunderstandings and providing the COVID-19 vaccine. These findings highlight gaps in communication and information, particularly regarding COVID-19 vaccines. GPs need high-quality information and resources to support them in undertaking complex risk communication with their patients.

Perceived public health threat a key factor for willingness to get the COVID-19 vaccine in Australia.

BACKGROUND: Vaccination rollout against COVID-19 is underway across multiple countries worldwide. Although the vaccine is free, rollout might still be compromised by hesitancy or concerns about COVID-19 vaccines. METHODS: We conducted two online surveys of Australian adults in April (during national lockdown; convenience cross-sectional sample) and November (very few cases of COVID-19; nationally representative sample) 2020, prior to vaccine rollout. We asked about intentions to have a potential COVID-19 vaccine (If a COVID-19 vaccine becomes available, I will get it) and free-text responses (November only). RESULTS: After adjustment for differences in sample demographics, the estimated proportion agreeing to a COVID-19 vaccine if it became available in April (n = 1146) was 76.3%. In November (n = 1941) this was estimated at 71.5% of the sample; additional analyses identified that the variation was driven by differences in perceived public health threat between April and November. Across both surveys, female gender, being younger, having inadequate health literacy and lower education were associated with reluctance to be vaccinated against COVID-19. Lower perceived susceptibility to COVID-19, belief that data on the efficacy of vaccines is 'largely made up', having lower confidence in government, and lower perception of COVID-19 as a public health threat, were also associated with reluctance to be vaccinated against COVID-19. The top three reasons for agreeing to vaccinate (November only) were to protect myself and others, moral responsibility, and having no reason not to get it. For those who were indifferent or disagreeing to vaccinate, safety concerns were the top reason, followed by indecision and lack of trust in the vaccine respectively. CONCLUSIONS: These findings highlight some factors related to willingness to accept a COVID-19 vaccine prior to one being available in Australia. Now that the vaccine is being offered, this study identifies key issues that can inform public health messaging to address vaccine hesitancy.

Contextualising COVID-19 prevention behaviour over time in Australia: Patterns and long-term predictors from April to July 2020 in an online social media sample.

BACKGROUND: In Australia in March 2020 a national public health directive required that non-essential workers stay at home, except for essential activities. These restrictions began easing in May 2020 as community transmission slowed. OBJECTIVES: This study investigated changes in COVID prevention behaviours from April-July 2020, and psychosocial predictors of these behaviours. METHODS: An Australia-wide (national) survey was conducted in April, with monthly follow-up over four months. Participants who were adults (18+ years), currently residing in Australia and who could read and understand English were eligible. Recruitment was via online social media. Analysis sample included those who provided responses to the baseline survey (April) and at least one subsequent follow-up survey (N = 1834 out of a possible 3216 who completed the April survey). 71.7% of the sample was female (n = 1,322). Principal components analysis (PCA) combined self-reported adherence across seven prevention behaviours. PCA identified two behaviour types: 'distancing' (e.g. staying 1.5m away) and 'hygiene' (e.g. washing hands), explaining 28.3% and 24.2% of variance, respectively. Distancing and hygiene behaviours were analysed individually using multivariable regression models. RESULTS: On average, participants agreed with statements of adherence for all behaviours (means all above 4 out of 7). Distancing behaviours declined each month (p's < .001), whereas hygiene behaviours remained relatively stable. For distancing, stronger perceptions of societal risk, self-efficacy to maintain distancing, and greater perceived social obligation at baseline were associated with adherence in June and July (p's<0.05). For hygiene, the only significant correlate of adherence in June and July was belief that one's actions could prevent infection of family members (p < .001). CONCLUSION: High adherence to COVID prevention behaviours were reported in this social media sample; however, distancing behaviours tended to decrease over time. Belief in social responsibility may be an important aspect to consider in encouraging distancing behaviours. These findings have implications for managing a shift from government-imposed restrictions to individual responsibility.

The Psychological Impact of Hypertension During COVID-19 Restrictions: Retrospective Case-Control Study.

BACKGROUND: It is unclear how people with hypertension are responding to the COVID-19 pandemic given their increased risk, and whether targeted public health strategies are needed. OBJECTIVE: This retrospective case-control study compared people with hypertension to matched healthy controls during the COVID-19 lockdown to determine whether they have higher risk perceptions, anxiety, and vaccination intentions. METHODS: Baseline data from a national survey were collected in April 2020 during the COVID-19 lockdown in Australia. People who reported hypertension with no other chronic conditions were randomly matched to healthy controls of similar age, gender, education, and health literacy level. A subset including participants with hypertension was followed up at 2 months after restrictions were eased. Risk perceptions, anxiety, and vaccination intentions were measured in April and June. RESULTS: Of the 4362 baseline participants, 466 (10.7%) reported hypertension with no other chronic conditions. A subset of 1369 people were followed up at 2 months, which included 147 (10.7%) participants with hypertension. At baseline, perceived seriousness was high for both hypertension and control groups. The hypertension group reported greater anxiety compared to the controls and were more willing to vaccinate against influenza, but COVID-19 vaccination intentions were similar. At follow-up, these differences were no longer present in the longitudinal subsample. Perceived seriousness and anxiety had decreased, but vaccination intentions for both influenza and COVID-19 remained high across groups (>80%). CONCLUSIONS: Anxiety was above normal levels during the COVID-19 lockdown. It was higher in the hypertension group, which also had higher vaccination intentions. Groups that are more vulnerable to COVID-19 may require targeted mental health screening during periods of greater risk. Despite a decrease in perceived risk and anxiety after 2 months of lockdown restrictions, vaccination intentions remained high, which is encouraging for the future prevention of COVID-19.

Positive outcomes associated with the COVID-19 pandemic in Australia.

ISSUE ADDRESSED: To investigate whether Australians have experienced any positive effects during the COVID-19 pandemic. METHODS: National online longitudinal survey. As part of a June 2020 survey, participants (n = 1370) were asked 'In your life, have you experienced any positive effects from the COVID-19 pandemic' (yes/no) and also completed the World Health Organisation-Five well-being index. Differences were explored by demographic variables. Free-text responses were thematically coded. RESULTS: Nine hundred sixty participants (70%) reported experiencing at least one positive effect during the COVID-19 pandemic. Living with others (P = .045) and employment situation (P < .001) at baseline (April) were associated with experiencing positive effects. Individuals working for pay from home were more likely to experience positive effects compared to those who were not working for pay (aOR = 0.45, 95% CI: 0.32, 0.63, P < .001) or who were working for pay outside the home (aOR = 0.40, 95% CI: 0.28, 0.58, P < .001). 54.2% of participants reported a sufficient level of well-being, 23.2% low well-being and a further 22.6% very low well-being. Of those experiencing positive effects, 945/960 (98%) provided an explanation. The three most common themes were 'Family time' (33%), 'Work flexibility' (29%) and 'Calmer life' (19%). CONCLUSIONS: A large proportion of participants reported positive effects resulting from changes to daily life due to the COVID-19 pandemic in Australia. SO WHAT: The needs of people living alone, and of those having to work outside the home or who are unemployed, should be considered by health policymakers and employers in future pandemic preparedness efforts.