Impacts of the COVID-19 pandemic impact on healthcare professional delivery of opportunistic behaviour change interventions: a retrospective cohort study (preprint)

BACKGROUND The public health policy “Making Every Contact Count” (MECC) compels healthcare professionals to deliver behaviour change interventions during routine consultations. The COVID-19 pandemic and its mitigations have stretched services, yet supporting people to modify health behaviours is more important now than when the policy was introduced. The present study aims to: (a) examine changes in healthcare professionals’ awareness of, and engagement with the policy over a five-year period, (b) examine the psychosocial drivers associated with delivering behaviour change interventions, and (c) identify targets to increase healthcare professionals’ delivery of interventions.METHODS Comparison of data from two independent representative surveys of NHS healthcare professionals working in the UK. In both surveys (July-September 2017; N = 1387, and February-March 2022; N = 1008), participants were asked to report: (1) awareness of the MECC policy, (2) the prevalence of MECC-related practice (perceived patient benefit, how often interventions were delivered, and time spent delivering interventions), and (3) perceptions of capabilities, opportunities and motivations to deliver behaviour change interventions. T- tests (independent-samples), MANOVA, multiple linear regression, and chi-square analyses were used to generate comparisons between the surveys.RESULTS Awareness of the policy increased from 2017 (31.4%) to 2022 (52.0%). However, in 2022 compared with 2017, healthcare professionals reported (a) fewer patients would benefit from behaviour change interventions (49.1% versus 55.9%), (b) they delivered behaviour change interventions to a lower proportion of patients (38.0% versus 50.0%), and (c) they spent a lower proportion of the consultation time delivering interventions (26.5% versus 35.3%). Further, in 2022, compared with 2017, healthcare professionals reported fewer physical opportunities, fewer social opportunities, and fewer psychological capabilities to deliver behaviour change interventions. In the 2022 survey, perceptions of patient benefit and delivery of interventions was associated with greater perceptions of opportunities and motivations.CONCLUSIONS Health behaviour change interventions are crucial to avert an impending public health crisis following COVID-19, however reported engagement with MECC-related practices appears to have reduced over time. Future research should consider how healthcare professionals identify patients who might benefit from opportunistic behaviour change interventions, and to increase capabilities, opportunities, and motivations to deliver interventions during routine consultations.

Public perceptions of non-adherence to COVID-19 measures by self and others in the United Kingdom (preprint)

OBJECTIVETo explore the perceptions of non-adherence to COVID-19 policy measures by self and others in the UK, focusing on perceived reasons for non-adherence. DESIGNQualitative study comprising 12 online focus groups conducted between 25th September and 13th November 2020. SETTINGOnline video-conferencing PARTICIPANTS51 UK residents aged 18 and above, reflecting a range of ages, genders and race/ethnicities. RESULTSParticipants reported seeing an increase in non-adherence in others and identified a number of challenges to their own adherence to measures. Thematic analysis identified six main themes related to participants reported reasons for non-adherence in self and others: (1) Alert fatigue (2) Inconsistent rules (3) Lack of trust in government (4) Helplessness (5) Resistance and rebelliousness (6) Reduced perception of risk and the prospect of a vaccine. Participants also raised concerns that adherence would be impacted by a desire to socialise over Christmas. Two forms of non-adherence were observed: overt rule- breaking and subjective rule interpretation. CONCLUSIONSAdherence may be improved by: less frequent and clearer information on COVID-19 to reduce alert fatigue; implementing a more unified set of measures within and across countries in the UK; role modelling good adherence by authority figures; exploring ways to mitigate the impact that events like Christmas vaccine breakthroughs may have on reducing adherence.

Public attitudes towards COVID-19 contact tracing apps: A UK-based focus group study (preprint)

OBJECTIVETo explore public attitudes to the proposed COVID-19 contact tracing app in the United Kingdom. DESIGNQualitative study consisting of five focus groups carried out between 1st-4th May, 2020 (39-42 days after the official start of the UK lockdown). SETTINGOnline video-conferencing PARTICIPANTS22 participants, all UK residents aged 18 years and older, representing a range of different genders, ages, ethnicities and locations. RESULTSParticipants were split roughly equally in number across three groups: will use the app; will not be using the app; and undecided as to whether they will use the app. Analysis revealed five main themes: (1) Lack of information and misconceptions surrounding COVID-19 contact tracing apps; (2) concerns over privacy; (3) concerns over stigma; (4) concerns over uptake; and (5) contact tracing as the greater good. These themes were found across the sample and the three groups. However, concerns over privacy, uptake and stigma were particularly significant amongst those state they will not be using the app and the view that the app is for the "greater good" was particularly significant amongst those who stated they will be using the app. One of the most common misconceptions about the app was that it could allow users to specifically identify and map COVID-19 cases amongst their contacts and in their vicinity. CONCLUSIONSWe offer four recommendations: (1) To offset the fact that many people may not be accessing, or might be avoiding, news coverage on COVID-19, authorities must communicate to the public via a range of methods including but not limited to: social media ads, postal information, text messaging and other emergency alert systems. (2) Communications should emphasise that the app cannot enable the user to identify which of their contacts has reported COVID-19 symptoms or tested positive. (3) Communication should emphasise collective responsibility ( the greater good) to promote social norms around use of the app (4) Communication should provide a slogan that maximises clarity of message, for example: Download the app, protect the NHS, save lives.

Public perceptions and experiences of social distancing and social isolation during the COVID-19 pandemic: A UK-based focus group study (preprint)

OBJECTIVE: Explore the perceptions and experiences of the UK public of social distancing and social isolation measures related to the COVID-19 pandemic. DESIGN: Qualitative study comprising five focus groups carried out online during the early stages of the UK's social distancing and isolation measures (5-12 days post lockdown). SETTING: Online video-conferencing PARTICIPANTS: 27 participants, all UK residents aged 18 years and older, representing a range of gender, ethnic, age and occupational backgrounds. RESULTS: The social distancing and isolation associated with COVID-19 policy has had having substantial negative impacts on the mental health and wellbeing of the UK public within a short time of policy implementation. It has disproportionately negatively affected those in low-paid or precarious employment. Practical social and economic losses - the loss of (in-person) social interaction, loss of income and loss of structure and routine - led to psychological and emotional 'losses' - the loss of motivation, loss of meaning, and loss of self-worth. Participants reported high adherence to distancing and isolation guidelines but reported seeing or hearing of non-adherence in others. A central concern for participants was the uncertainty duration of the measures, and their ability to cope longer-term. Some participants felt they would have lingering concerns over social contact while others were eager to return to high levels of social activity. CONCLUSIONS: A rapid response is necessary in terms of public health programming to mitigate the mental health impacts of COVID-19 social distancing and isolation. Initial high levels of support for, and adherence to, social distancing and isolation is likely to wane over time, particularly where end dates are uncertain. Social distancing and isolation 'exit strategies' must account for the fact that, although some individuals will voluntarily or habitually continue to socially distance, others will seek high levels of social engagement as soon as possible.