Challenges to self-isolation among contacts of cases of COVID-19: a national telephone survey in Wales.

BACKGROUND: Self-isolation is challenging and adherence is dependent on a range of psychological, social and economic factors. We aimed to identify the challenges experienced by contacts of coronavirus disease 2019 (COVID-19) cases to better target support and minimize the harms of self-isolation. METHODS: The Contact Adherence Behavioural Insights Study (CABINS) was a 15-minute telephone survey conducted with confirmed contacts of COVID-19 (N = 2027), identified through the NHS Wales Test Trace Protect (TTP) database. RESULTS: Younger people (aged 18-29 years) were three times more likely to report mental health concerns (adjusted odds ratio [aOR]: 3.16, 95% confidence interval [CI]: 2.05-4.86) and two times more likely to report loneliness (aOR: 1.96, CI: 1.37-2.81) compared to people aged over 60 years. Women were 1.5 times more likely to experience mental health concerns (aOR: 1.51, 95% CI: 1.20-1.92) compared to men. People with high levels of income precarity were eight times more likely to report financial challenges (aOR: 7.73, CI: 5.10-11.74) and three times more likely to report mental health concerns than their more financially secure counterparts (aOR: 3.08, CI: 2.22-4.28). CONCLUSION: Self-isolation is particularly challenging for younger people, women and those with precarious incomes. Providing enhanced support is required to minimize the harms of self-isolation.

Precarious employment and self-reported health: a cross-sectional analysis

Background Associations between precarious employment and poorer health outcomes are well documented. However, which components of this multidimensional construct are associated with adverse health is unknown. The primary aim of this study was to examine associations between the different domains of precarious employment and self-reported health. Methods We used data from 1016 respondents (634 women and 382) to the COVID-19 Employment and Health in Wales Study, a nationally representative household survey of the so-called working-age population (18–64 years). The study was done on May 25 and June 22, 2020, using a push-to-web approach (letter invitation to an online survey;response rate: 6·9%). Respondents provided details of their main job in February, 2020, including information on their contract type and different domains of employment precariousness as assessed by the Employment Precariousness Scale. These domains were: temporariness (length of time working under temporary arrangements);disempowerment (control over work schedule);vulnerability (perceived treatment at work);wages (pay and ability to afford basic and unexpected expenses);and rights. Health measures were self-reported pre-existing health conditions, general health, and mental wellbeing (calculated with the Short Warwick Edinburgh Mental Wellbeing Score). To examine associations between domains of precarious employment and health, chi-squared analysis and multinomial logistic regression (adjusted for sex, age, deprivation, contract type, and self-reported health) were done. The Health Research Authority approved this study (Integrated Research Application System reference: 282223). Findings The domains of precarious employment that showed the strongest associations with poor health, independently of contract type, were high vulnerability precariousness (associated with pre-existing condition: adjusted odds ratio 2·44 [95% CI 1·32–4·49], p=0·004;poor general health: 2·35 [1·23–4·51], p=0·010;low mental wellbeing: 2·74 [1·30–5·75], p=0·008);high wage precariousness (associated with pre-existing condition: 1·66 [1·08–2·57], p=0·022;poor general health: 2·21 [1·33–3·69], p=0·002;low mental wellbeing: 3·16 [1·54–6·45], p=0·002);and moderate wage precariousness (associated with pre-existing condition: 1·68 [1·20–2·36], p=0·003;and low mental wellbeing: 2·25 [1·19–4·29], p=0·013). Interpretation Before the COVID-19 pandemic, tackling poverty in those in work and perceived fair treatment in the workplace appear to have been important in improving the health of the working-age population of the UK. Longitudinal analyses are required to establish the effect of the pandemic on employment conditions and on whether these domains remain adversely associated with health. Funding No funding to declare.

Challenges of self-isolation among contacts of cases of COVID-19: a national telephone survey in Wales

Background Self-isolation is known to be challenging and adherence is dependent on a range of psychological, social, and economic factors. We aimed to identify the specific challenges experienced by contacts of COVID-19 cases to better target support and minimise the harms of self-isolation. Methods The Contact Adherence Behavioural Insights Study (CABINS) was a 15 min telephone survey of contacts of COVID-19 cases, identified through NHS Wales Test Trace Protect (TTP). Quota sampling by age, gender (interlocked), and Welsh Index of Multiple Deprivation (WIMD) was used to ensure a representative sample of those in the TTP database. Logistic regression models adjusted for age, gender, living alone, time period, WIMD, and income precarity (financial insecurity) established which subgroups were more likely to experience challenges. Ethical approval was gained from the NHS Research Ethics Committee and the Public Health Wales Research and Development Office. Informed consent was gained from participants at the beginning of the telephone call. Findings We identified 47 072 eligible contacts (24 825 female, 23 090 male, and 10 542 did not say) who were informed to self-isolate over two periods (period 1 [regional lockdowns in place;no financial support available]: Sept 13, 2020, to Oct 23, 2020 [n=18 568];period 2 [during a national lockdown;self-isolation support payments available]: Dec 13, 2020, to Jan 16, 2021 [n=28 504]). 10 801 were invited to participate (5092 from period 1, 5709 from period 2);2027 (18·8%) completed the survey. People with high income precarity were almost eight times more likely to report financial challenges (adjusted odds ratio 7·73;95% CI 5·10–11·74) and three times more likely to report mental health concerns (3·08;2·22–4·28) than their more financially secure counterparts. Younger people (18–29 years) were twice as likely to report loneliness (1·96;1·37–2·81) and three times more likely to report mental health concerns (3·16;2·05–4·86) than individuals aged 60 years and older. Women were nearly twice as likely to experience mental health difficulties as men (1·51;1·20–1·92). No effects of WIMD were found. Findings were similar between the two periods. Interpretation Financial challenges of self-isolation were particularly acute among those individuals with high income precarity, and younger people and women had considerable mental health challenges. During the pandemic, Welsh Government and local TTP teams used this insight to target financial and mental health support to those with greatest need. Despite easing of self-isolation requirements for contacts of COVID-19 cases, identifying these groups remains important for future pandemics and the provision of financial and social support. Funding Project funded internally by Public Health Wales.