Novel intervention to promote COVID-19 protective behaviours among Black and South Asian communities in the UK: protocol for a mixed-methods pilot evaluation.

INTRODUCTION: Culturally appropriate interventions to promote COVID-19 health protective measures among Black and South Asian communities in the UK are needed. We aim to carry out a preliminary evaluation of an intervention to reduce risk of COVID-19 comprising a short film and electronic leaflet. METHODS AND ANALYSIS: This mixed methods study comprises (1) a focus group to understand how people from the relevant communities interpret and understand the intervention's messages, (2) a before-and-after questionnaire study examining the extent to which the intervention changes intentions and confidence to carry out COVID-19 protective behaviours and (3) a further qualitative study exploring the views of Black and South Asian people of the intervention and the experiences of health professionals offering the intervention. Participants will be recruited through general practices. Data collection will be carried out in the community. ETHICS AND DISSEMINATION: The study received Health Research Authority approval in June 2021 (Research Ethics Committee Reference 21/LO/0452). All participants provided informed consent. As well as publishing the findings in peer-reviewed journals, we will disseminate the findings through the UK Health Security Agency, NHS England and the Office for Health Improvement and Disparities and ensure culturally appropriate messaging for participants and other members of the target groups.

Identity-based social support predicts mental and physical health outcomes during COVID-19.

During the COVID-19 pandemic, the United Kingdom implemented physical distancing measures to minimize viral transmission, which may have adversely impacted health and wellbeing. Evidence suggests that social support may be key to mitigating against adverse health impacts of such measures, particularly when such social support is identity-based. In this longitudinal study, we examined the role of social identity and perceived social support in mental and physical health outcomes during the COVID-19 pandemic. Participants completed a survey at 4 time points during the first year of the pandemic: May/June 2020 (T1; N = 443); September/October 2020 (T2; N = 235); December 2020/January 2021 (T3; N = 243); and April 2021 (T4; N = 206). Results showed that at each time point, social support was predicted by identification with multiple groups before COVID-19, identity continuity, and identification with communities. Higher identity continuity and identification with communities both predicted greater mental and physical health at the same time point, mediated by perceived social support. Interestingly, higher identity continuity and identification with communities predicted higher social support at the same time point, which in turn predicted worse mental and physical health outcomes at the subsequent time point. Findings are discussed in relation to the context of the first year of the pandemic and the changing nature of societal restrictions across the four survey time points.

Understanding the Public's Attitudes Toward COVID-19 Vaccines in Nottinghamshire, United Kingdom: Qualitative Social Media Analysis.

BACKGROUND: COVID-19 vaccines remain central to the UK government's plan for tackling the COVID-19 pandemic. Average uptake of 3 doses in the United Kingdom stood at 66.7% as of March 2022; however, this rate varies across localities. Understanding the views of groups who have low vaccine uptake is crucial to guide efforts to improve vaccine uptake. OBJECTIVE: This study aims to understand the public's attitudes toward COVID-19 vaccines in Nottinghamshire, United Kingdom. METHODS: A qualitative thematic analysis of social media posts from Nottinghamshire-based profiles and data sources was conducted. A manual search strategy was used to search the Nottingham Post website and local Facebook and Twitter accounts from September 2021 to October 2021. Only comments in the public domain and in English were included in the analysis. RESULTS: A total of 3508 comments from 1238 users on COVID-19 vaccine posts by 10 different local organizations were analyzed, and 6 overarching themes were identified: trust in the vaccines, often characterized by a lack of trust in vaccine information, information sources including the media, and the government; beliefs about safety including doubts about the speed of development and approval process, the severity of side effects, and belief that the ingredients are harmful; belief that the vaccines are not effective as people can still become infected and spread the virus and that the vaccines may increase transmission through shedding; belief that the vaccines are not necessary due to low perceived risk of death and severe outcomes and use of other protective measures such as natural immunity, ventilation, testing, face coverings, and self-isolation; individual rights and freedoms to be able to choose to be vaccinated or not without judgement or discrimination; and barriers to physical access. CONCLUSIONS: The findings revealed a wide range of beliefs and attitudes toward COVID-19 vaccination. Implications for the vaccine program in Nottinghamshire include communication strategies delivered by trusted sources to address the gaps in knowledge identified while acknowledging some negatives such as side effects alongside emphasizing the benefits. These strategies should avoid perpetuating myths and avoid using scare tactics when addressing risk perceptions. Accessibility should also be considered with a review of current vaccination site locations, opening hours, and transport links. Additional research may benefit from using qualitative interviews or focus groups to further probe on the themes identified and explore the acceptability of the recommended interventions.

Prioritising Climate Change Mitigation Behaviours and Exploring Public Health Co-Benefits: A Delphi Study.

Climate change requires urgent action; however, it can be challenging to identify individual-level behaviours that should be prioritised for maximum impact. The study aimed to prioritise climate change mitigation behaviours according to their impacts on climate change and public health, and to identify associated barriers and facilitators-exploring the impact of observed behaviour shifts associated with COVID-19 in the UK. A three-round Delphi study and expert workshop were conducted: An expert panel rated mitigation behaviours impacted by COVID-19 in relation to their importance regarding health impacts and climate change mitigation using a five-point Likert scale. Consensus on the importance of target behaviours was determined by interquartile ranges. In total, seven target behaviours were prioritised: installing double/triple glazing; installing cavity wall insulation; installing solid wall insulation; moving away from meat/emission heavy diets; reducing the number of cars per household; walking shorter journeys; and reducing day/weekend leisure car journeys. Barriers related to the costs associated with performing behaviours and a lack of complementary policy-regulated subsidies. The target behaviours are consistent with recommendations from previous research. To ensure public uptake, interventions should address behavioural facilitators and barriers, dovetail climate change mitigation with health co-benefits and account for the long-term impacts of COVID-19 on these behaviours.

Variations in classroom ventilation during the COVID-19 pandemic: Insights from monitoring 36 naturally ventilated classrooms in the UK during 2021

Seasonal changes in the measured CO2 levels at four schools are herein presented through a set of indoor air quality metrics that were gathered during the height of the COVID-19 pandemic in the UK. Data from non-intrusive environmental monitoring units were remotely collected throughout 2021 from 36 naturally ventilated classrooms at two primary schools and two secondary schools in England. Measurements were analysed to assess the indoor CO2 concentration and temperature . Relative to UK school air quality guidance, the CO2 levels within classrooms remained relatively low during periods of warmer weather, with elevated CO2 levels being evident during the colder seasons, indicating lower levels of per person ventilation during these colder periods. However, CO2 data from the cold period during the latter part of 2021, imply that the per person classroom ventilation levels were significantly lower than those achieved during a similarly cold weather period during the early part of the year. Given that the classroom architecture and usage remained unchanged, this finding suggests that changes in the ventilation behaviours within the classrooms may have altered, and raises questions as to what may have given rise to such change, in a year when, messaging and public concerns regarding COVID-19 varied within the UK. Significant variations were observed when contrasting data, both between schools, and between classrooms within the same school building;suggesting that work is required to understand and catalogue the existing ventilation provisions and architecture within UK classrooms, and that more work is required to ascertain the effects of classroom ventilation behaviours.

The effects of messaging on long COVID expectations: An online experiment.

OBJECTIVE: We examined whether varying information about long COVID would affect expectations about the illness. METHOD: In October 2021, we conducted a 2 (Illness Description: long COVID vs. ongoing COVID-19 recovery) × 2 (Symptom Uncertainty: uncertainty emphasized vs. not emphasized) × 2 (Efficacy of Support: enhanced vs. basic support) between-subjects randomized online experimental study. Participants (N = 1,110) were presented with a scenario describing a positive COVID-19 test result, followed by one of eight scenarios describing a long COVID diagnosis and then completed outcome measures of illness expectations including: symptom severity, symptom duration, quality of life, personal control, treatment control, and illness coherence. RESULTS: We ran a series of 2 × 2 × 2 ANOVAs on the outcome variables. We found a main effect of illness description: individuals reported longer symptom duration and less illness coherence when the illness was described as long COVID (compared to ongoing COVID-19 recovery). There was a main effect of symptom uncertainty: when uncertainty was emphasized, participants reported longer expected symptom duration (p < .001), less treatment control (p = .031), and less illness coherence (p < .001) than when uncertainty was not emphasized. There was a main effect of efficacy of support: participants reported higher personal control (p = .004) and higher treatment control (p = .037) when support was enhanced (compared to basic support). CONCLUSIONS: Communications around long COVID should avoid emphasizing symptom uncertainty and aim to provide people with access to additional support and information on how they can facilitate their recovery. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The mental health of staff working on intensive care units over the COVID-19 winter surge of 2020 in England: a cross sectional survey.

BACKGROUND: The COVID-19 pandemic generated a surge of critically ill patients greater than the capacity of the UK National Health Service (NHS). There have been multiple well-documented impacts associated with the national COVID-19 pandemic surge on ICU staff, including an increased prevalence of mental health disorders on a scale potentially sufficient to impair high-quality care delivery. We investigated the prevalence of five mental health outcomes; explored demographic and professional predictors of poor mental health outcomes; and describe the prevalence of functional impairment; and explore demographic and professional predictors of functional impairment in ICU staff over the 2020/2021 winter COVID-19 surge in England. METHODS: English ICU staff were surveyed before, during, and after the winter 2020/2021 surge using a survey which comprised validated measures of mental health. RESULTS: A total of 6080 surveys were completed, by ICU nurses (57.5%), doctors (27.9%), and other healthcare staff (14.5%). Reporting probable mental health disorders increased from 51% (before) to 64% (during), and then decreased to 46% (after). Younger, less experienced nursing staff were most likely to report probable mental health disorders. During and after the winter, >50% of participants met threshold criteria for functional impairment. Staff who reported probable post-traumatic stress disorder, anxiety, or depression were more likely to meet threshold criteria for functional impairment. CONCLUSIONS: The winter of 2020/2021 was associated with an increase in poor mental health outcomes and functional impairment amongst ICU staff during a period of peak caseload. These effects are likely to impact on patient care outcomes and the longer-term resilience of the healthcare workforce.

Impact of residual risk messaging to reduce false reassurance following test-negative results from asymptomatic coronavirus (SARS-CoV-2) testing: an online experimental study of a hypothetical test.

OBJECTIVES: Individuals who receive a negative lateral flow coronavirus test result may misunderstand it as meaning 'no risk of infectiousness', giving false reassurance. This experiment tested the impact of adding information to negative test result messages about residual risk and the need to continue protective behaviours. DESIGN: 4 (residual risk) × 2 (post-test result behaviours) between-subjects design. SETTING: Online. PARTICIPANTS: 1200 adults from a representative UK sample recruited via Prolific (12-15 March 2021). INTERVENTIONS: Participants were randomly allocated to one of eight messages. Residual risk messages were: (1) 'Your coronavirus test result is negative' (control); (2) message 1 plus 'It's likely you were not infectious when the test was done' (current NHS Test & Trace (T&T); (3) message 2 plus 'But there is still a chance you may be infectious' (elaborated NHS T&T); and (4) message 3 plus infographic depicting residual risk (elaborated NHS T&T+infographic). Each message contained either no additional information or information about the need to continue following guidelines and protective behaviours. OUTCOME MEASURES: (1) Proportion understanding residual risk of infectiousness and (2) likelihood of engaging in protective behaviours (scales 1-7). RESULTS: The control message decreased understanding relative to the current NHS T&T message: 54% versus 71% (Adjusted Odds Ratio (AOR)=0.56 95% CI 0.34 to 0.95, p=0.030). Understanding increased with the elaborated NHS T&T (89%; AOR=3.25 95% CI 1.64 to 6.42, p=0.001) and elaborated NHS T&T+infographic (91%; AOR=5.16 95% CI 2.47 to 10.82, p<0.001) compared with current NHS T&T message. Likelihood of engaging in protective behaviours was unaffected by information (AOR=1.11 95% CI 0.69 to 1.80, χ2(1)=0.18, p=0.669), being high (M=6.4, SD=0.9) across the sample. CONCLUSIONS: A considerable proportion of participants misunderstood the residual risk following a negative test result. The addition of a single sentence ('But there is still a chance you may be infectious') to current NHS T&T wording increased understanding of residual risk. TRIAL REGISTRATION NUMBER: OSF: https://osf.io/byfz3/.

The Effectiveness of Interventions for Increasing COVID-19 Vaccine Uptake: A Systematic Review.

Vaccination is vital to protect the public against COVID-19. The aim of this systematic review is to identify and evaluate the effectiveness of interventions to increase COVID-19 vaccine uptake. We searched a range of databases (Embase, Medline, Psychology & Behavioral Science, PsycInfo, Web of Science and NIH Preprints Portfolio) from March 2020 to July 2021 for studies which reported primary quantitative or qualitative research on interventions to increase COVID-19 vaccine uptake. Outcome measures included vaccination uptake and reported intention to vaccinate. Reviews, position papers, conference abstracts, protocol papers and papers not in English were excluded. The NHLBI quality assessment was used to assess risk of bias. In total, 39 studies across 33 papers met the inclusion criteria. A total of 28 were assessed as good quality. They included interventions relating to communication content, communication delivery, communication presentation, policy or vaccination delivery, with 7 measuring vaccination uptake and 32 measuring vaccination intention. A narrative synthesis was conducted, which highlighted that there is reasonable evidence from studies investigating real behaviour suggesting that personalising communications and sending booking reminders via text message increases vaccine uptake. Findings on vaccination intention are mixed but suggest that communicating uncertainty about the vaccine does not decrease intention, whereas making vaccination mandatory could have a negative impact. Although much of the research used experimental designs, very few measured real behavioural outcomes. Understanding which interventions are most effective amongst vaccine-hesitant populations and in the context of booster vaccinations will be important as vaccine roll outs continue across the world.

Location, location, location: a discrete choice experiment to inform COVID-19 vaccination programme delivery in the UK.

BACKGROUND: Large-scale vaccination is fundamental to combatting COVID-19. In March 2021, the UK's vaccination programme had delivered vaccines to large proportions of older and more vulnerable population groups; however, there was concern that uptake would be lower among young people. This research was designed to elicit the preferences of 18-29-year-olds regarding key delivery characteristics and assess the influence of these on intentions to get vaccinated, to inform planning for this cohort. METHODS: From 25 March to 2 April 2021, an online sample of 2012 UK adults aged 18-29 years participated in a Discrete Choice Experiment. Participants made six choices, each involving two SMS invitations to book a vaccination appointment and an opt-out. Invitations had four attributes (1 × 5 levels, 3 × 3 levels): delivery mode, appointment timing, proximity, and sender. These were systematically varied according to a d-optimal design. Responses were analysed using a mixed logit model. RESULTS: The main effects logit model revealed a large alternative-specific constant (ß = 1.385, SE = 0.067, p < 0.001), indicating a strong preference for 'opting in' to appointment invitations. Pharmacies were dispreferred to the local vaccination centre (ß = - 0.256, SE = 0.072, p < 0.001), appointments in locations that were 30-45 min travel time from one's premises were dispreferred to locations that were less than 15 min away (ß = - 0.408, SE = 0.054, p < 0.001), and, compared to invitations from the NHS, SMSs forwarded by 'a friend' were dispreferred (ß = - 0.615, SE = 0.056, p < 0.001) but invitations from the General Practitioner were preferred (ß = 0.105, SE = 0.048, p = 0.028). CONCLUSIONS: The results indicated that the existing configuration of the UK's vaccination programme was well-placed to deliver vaccines to 18-29-year-olds; however, some adjustments might enhance acceptance. Local pharmacies were not preferred; long travel times were a disincentive but close proximity (0-15 min from one's premises) was not necessary; and either the 'NHS' or 'Your GP' would serve as adequate invitation sources. This research informed COVID-19 policy in the UK, and contributes to a wider body of Discrete Choice Experiment evidence on citizens' preferences, requirements and predicted behaviours regarding COVID-19.

Durham University students’ experiences of asymptomatic COVID-19 testing: a qualitative study

ObjectivesTo evaluate the asymptomatic coronavirus testing programme at Durham University by exploring students’ barriers and facilitators to taking part and provide recommendations to improve the programme.DesignQualitative interviews.SettingOnline.Participants30 students enrolled at Durham University were interviewed in March 2021.Main outcome measuresAttitudes towards testing, experiences of testing and barriers and facilitators to engaging in testing at Durham University.ResultsKey motivations for testing included protecting oneself and others and accessing facilities and events. The process of booking, accessing and doing a test was mostly easy and convenient, although some may prefer home testing. There were concerns about the accuracy of tests and the implications of a positive result. Some highlighted they might be less likely to engage in testing if vaccinated. A negative test result provided confidence to engage in their daily activities, while encouraging some to socialise more.ConclusionsThe findings show that the testing programme at Durham University is convenient and well organised, with testing as a potential requirement to access social events, and self-isolation support being key contributor to uptake. These findings provide insights into young adults’ attitudes towards testing and can inform testing programmes in other universities and settings with asymptomatic testing programmes.

Adherence to protective measures among healthcare workers in the UK: a cross-sectional study.

BACKGROUND: Healthcare workers (HCWs) are frontline responders to emergency infectious disease outbreaks such as COVID-19. To avoid the rapid spread of disease, adherence to protective measures is paramount. We investigated rates of correct use of personal protective equipment (PPE), hand hygiene and physical distancing in UK HCWs who had been to their workplace at the start of the COVID-19 pandemic and factors associated with adherence. METHODS: We used an online cross-sectional survey of 1035 UK healthcare professionals (data collected 12-16 June 2020). We excluded those who had not been to their workplace in the previous 6 weeks, leaving us with a sample size of 831. Respondents were asked about their use of PPE, hand hygiene and physical distancing in the workplace. Frequency of uptake was reported descriptively; adjusted logistic regressions were used to separately investigate factors associated with adherence to use of PPE, maintaining good hand hygiene and physical distancing from colleagues. RESULTS: Adherence to personal protective measures was suboptimal (PPE use: 80.0%, 95% CI 77.3 to 82.8; hand hygiene: 67.8%, 95% CI 64.6 to 71.0; coming into close contact with colleagues: 74.7%, 95% CI 71.7 to 77.7). Adherence to PPE use was associated with having received training about health and safety in the workplace for COVID-19, greater perceived social pressure to adopt the behaviour and availability of PPE. Non-adherence was associated with fatalism about COVID-19 and greater perceived difficulty of adopting protective measures. Workplace design using markings to facilitate distancing was associated with adherence to physical distancing. CONCLUSIONS: Uptake of personal protective behaviours among UK HCWs at the start of the pandemic was variable. Factors associated with adherence provide insight into ways to support HCWs to adopt personal protective behaviours, such as ensuring that adequate PPE is available and designing workplaces to facilitate physical distancing.

Experiences of supported isolation in returning travellers during the early COVID-19 response: a qualitative interview study.

OBJECTIVES: (1) To understand the experiences and perceptions of those who underwent supported isolation, particularly in relation to factors that were associated with improved compliance and well-being; (2) to inform recommendations for the management of similar supported isolation procedures. DESIGN: We carried out a qualitative study using semistructured interviews to capture participants' experiences and perceptions of supported isolation. Data were analysed using the framework approach, a type of thematic analysis that is commonly used in research that has implications for policy. SETTING: Telephone interviews carried out within approximately 1 month of an individual leaving supported isolation. PARTICIPANTS: 26 people who underwent supported isolation at either Arrowe Park Hospital (n=18) or Kents Hill Park Conference Centre (n=8) after being repatriated from Wuhan in January to February 2020. RESULTS: Six key themes were identified: factors affecting compliance with supported isolation; risk perceptions around catching COVID-19; management of supported isolation; communication with those outside supported isolation; relationship with others in supported isolation; and feelings on leaving supported isolation. Participants were willing to undergo supported isolation because they understood that it would protect themselves and others. Positive treatment by staff was fundamental to participants' willingness to comply with isolation procedures. Despite the high level of compliance, participants expressed some uncertainty about what the process would involve. CONCLUSIONS: As hotel quarantine is introduced across the UK for international arrivals, our findings suggest that those in charge should: communicate effectively before, during and after quarantine, emphasising why quarantine is important and how it will protect others; avoid coercion if possible and focus on supporting and promoting voluntary compliance; facilitate shared social experiences for those in quarantine; and ensure all necessary supplies are provided. Doing so is likely to increase adherence and reduce any negative effects on well-being.

A randomized controlled trial to test the effect of simplified guidance with visuals on comprehension of COVID-19 guidelines and intention to stay home if symptomatic.

BACKGROUND: In the COVID-19 pandemic, it is imperative that people understand and comply with self-isolation guidelines. We tested whether a simplified version of the guidelines and a simplified version with visual aids would affect comprehension and intention to self-isolate during the containment phase of the pandemic in the UK, in March 2020, compared to the standard guidelines. METHODS: We conducted an online, three-armed parallel randomized controlled trial. Participants were English and over 18. The survey software randomized them into conditions; they were blind to condition. The control group read the 7-page standard guidelines (the current version at the time of the trial). The intervention groups were given either a 3-page simplified version, with a summary box on the front page and numbered bullet points, or the same simplified version with pictograms illustrating the points in the box. Primary outcomes were comprehension of the guidelines, as measured by the number of correct answers given to six questions about the content, and the proportion who answered that they would 'definitely' stay at home for 7 days if symptomatic. FINDINGS: Recruitment was from 13 to 16 March 2020, with 1845 participants randomised and all data analysed. The Control group averaged 4.27 correct answers, the Simplified 4.20, and the Simplified + visual aids 4.13, out of a possible total of 6 correct answers. There were no differences in comprehension in the unadjusted models; however, when the model was adjusted for demographic variables, there was lower comprehension in the simplified + visual aids condition than in the control, (ß = - 0.16, p = 0.04998). There were no statistically significant differences in intention to stay home: Control was 85%, Simplified 83%, and Simplified + visual aids condition 84%. CONCLUSION: Simplified guidance did not improve comprehension compared to the standard guidance issued in the containment phase of the COVID-19 pandemic in March 2020, and simplified guidance with visual aids may even have worsened comprehension. Simplified guidance had no effect on intention to stay home if symptomatic. This trial informed COVID-19 policy and provides insights relevant to guidance production in the acute phase of a major public health emergency.

Research fatigue in COVID-19 pandemic and post-disaster research: Causes, consequences and recommendations.

PURPOSE: Research fatigue occurs when an individual or population of interest tires of engaging with research, consequently avoiding further participation. This paper considers research fatigue in the context of the current COVID-19 pandemic, to identify contributory factors and possible solutions for future post-disaster research. METHODOLOGY: We draw on examples from the literature and our own observations from the recruitment and data collection phases of qualitative and quantitative studies, to provide an overview of possible research fatigue in the current COVID-19 pandemic, with implications for future post-disaster research. FINDINGS: People affected by disasters sometimes receive multiple requests for study participation by separate teams who may not necessarily be coordinating their work. Not keeping participants informed of the research process or outcomes can lead to disillusionment. Being overburdened with too many research requests and failing to see any subsequent changes following participation may cause individuals to experience research fatigue. ORIGINALITY: Guidelines for researchers wishing to reduce the occurrence of research fatigue include ensuring greater transparency within research; sharing of results; and using oversight or gatekeeper bodies to aid coordination. Failure to restrict the number of times that people are asked to participate in studies risks poor participation rates. This can subsequently affect the quality of information with which to inform policy-makers and protect the health of the public during the COVID-19 pandemic or other public health disasters/emergencies.

Meaningful Big Data Integration for a Global COVID-19 Strategy

With the rapid spread of the COVID-19 pandemic, the novel Meaningful Integration of Data Analytics and Services (MIDAS) platform quickly demonstrates its value, relevance and transferability to this new global crisis. The MIDAS platform enables the connection of a large number of isolated heterogeneous data sources, and combines rich datasets including open and social data, ingesting and preparing these for the application of analytics, monitoring and research tools. These platforms will assist public health author ities in: (i) better understanding the disease and its impact;(ii) monitoring the different aspects of the evolution of the pandemic across a diverse range of groups;(iii) contributing to improved resilience against the impacts of this global crisis;and (iv) enhancing preparedness for future public health emergencies. The model of governance and ethical review, incorporated and defined within MIDAS, also addresses the complex privacy and ethical issues that the developing pandemic has highlighted, allowing oversight and scrutiny of more and richer data sources by users of the system.

Facilitators and barriers to engagement with contact tracing during infectious disease outbreaks: A rapid review of the evidence.

BACKGROUND: Until a vaccine is developed, a test, trace and isolate strategy is the most effective method of controlling the COVID-19 outbreak. Contact tracing and case isolation are common methods for controlling infectious disease outbreaks. However, the effectiveness of any contact tracing system rests on public engagement. Numerous factors may influence an individual's willingness to engage with a contact tracing system. Understanding these factors has become urgent during the COVID-19 pandemic. OBJECTIVE: To identify facilitators and barriers to uptake of, and engagement with, contact tracing during infectious disease outbreaks. METHOD: A rapid systematic review was conducted to identify papers based on primary research, written in English, and that assessed facilitators, barriers, and other factors associated with the uptake of, and engagement with, a contact tracing system. PRINCIPAL FINDINGS: Four themes were identified as facilitators to the uptake of, and engagement with, contact tracing: collective responsibility; personal benefit; co-production of contact tracing systems; and the perception of the system as efficient, rigorous and reliable. Five themes were identified as barriers to the uptake of, and engagement with, contact tracing: privacy concerns; mistrust and/or apprehension; unmet need for more information and support; fear of stigmatization; and mode-specific challenges. CONCLUSIONS: By focusing on the factors that have been identified, contact tracing services are more likely to get people to engage with them, identify more potentially ill contacts, and reduce transmission.

Examining the application of behaviour change theories in the context of infectious disease outbreaks and emergency response: a review of reviews.

BACKGROUND: Behavioural science can play a critical role in combatting the effects of an infectious disease outbreak or public health emergency, such as the COVID-19 pandemic. The current paper presents a synthesis of review literature discussing the application of behaviour change theories within an infectious disease and emergency response context, with a view to informing infectious disease modelling, research and public health practice. METHODS: A scoping review procedure was adopted for the searches. Searches were run on PubMed, PsychInfo and Medline with search terms covering four major categories: behaviour, emergency response (e.g., infectious disease, preparedness, mass emergency), theoretical models, and reviews. Three further top-up reviews was also conducted using Google Scholar. Papers were included if they presented a review of theoretical models as applied to understanding preventative health behaviours in the context of emergency preparedness and response, and/or infectious disease outbreaks. RESULTS: Thirteen papers were included in the final synthesis. Across the reviews, several theories of behaviour change were identified as more commonly cited within this context, specifically, Health Belief Model, Theory of Planned Behaviour, and Protection Motivation Theory, with support (although not universal) for their effectiveness in this context. Furthermore, the application of these theories in previous primary research within this context was found to be patchy, and so further work is required to systematically incorporate and test behaviour change models within public health emergency research and interventions. CONCLUSION: Overall, this review identifies a range of more commonly applied theories with broad support for their use within an infectious disease and emergency response context. The Discussion section details several key recommendations to help researchers, practitioners, and infectious disease modellers to incorporate these theories into their work. Specifically, researchers and practitioners should base future research and practice on a systematic application of theories, beginning with those reported herein. Furthermore, infectious disease modellers should consult the theories reported herein to ensure that the full range of relevant constructs (cognitive, emotional and social) are incorporated into their models. In all cases, consultation with behavioural scientists throughout these processes is strongly recommended to ensure the appropriate application of theory.

The impact of unplanned school closure on children's social contact: rapid evidence review.

BackgroundEmergency school closures are often used as public health interventions during infectious disease outbreaks to minimise the spread of infection. However, if children continue mixing with others outside the home during closures, the effect of these measures may be limited.AimThis review aimed to summarise existing literature on children's activities and contacts made outside the home during unplanned school closures.MethodsIn February 2020, we searched four databases, MEDLINE, PsycInfo, Embase and Web of Science, from inception to 5 February 2020 for papers published in English or Italian in peer-reviewed journals reporting on primary research exploring children's social activities during unplanned school closures. Main findings were extracted.ResultsA total of 3,343 citations were screened and 19 included in the review. Activities and social contacts appeared to decrease during closures, but contact remained common. All studies reported children leaving the home or being cared for by non-household members. There was some evidence that older child age (two studies) and parental disagreement (two studies) with closure were predictive of children leaving the home, and mixed evidence regarding the relationship between infection status and such. Parental agreement with closure was generally high, but some disagreed because of perceived low risk of infection and issues regarding childcare and financial impact.ConclusionEvidence suggests that many children continue to leave home and mix with others during school closures despite public health recommendations to avoid social contact. This review of behaviour during unplanned school closures could be used to improve infectious disease modelling.