RESUMO
BackgroundHealthcare workers (HCWs) have provided vital services during the COVID-19 pandemic, but existing research consists of quantitative surveys (lacking in depth or context) or qualitative interviews (with limited generalisability). Structural Topic Modelling (STM) of large-scale free-text survey data offers a way of capturing the perspectives of a wide range of HCWs in their own words about their experiences of the pandemic. MethodsIn an online survey distributed to all staff at 18 geographically dispersed NHS Trusts, we asked respondents, "Is there anything else you think we should know about your experiences of the COVID-19 pandemic?". We used STM on 7,412 responses to identify topics, and thematic analysis on the resultant topics and text excerpts. ResultsWe identified 33 topics, grouped into two domains, each containing four themes. Our findings emphasise: the deleterious effect of increased workloads, lack of PPE, inconsistent advice/guidance, and lack of autonomy; differing experiences of home working as negative/positive; and the benefits of supportive leadership and peers in ameliorating challenges. Themes varied by demographics and time: discussion of home working decreasing over time, while discussion of workplace challenges increased. Discussion of mental health was lowest between September-November 2020, between the first and second waves of COVID-19 in the UK. DiscussionOur findings represent the most salient experiences of HCWs through the pandemic. STM enabled statistical examination of how the qualitative themes raised differed according to participant characteristics. This relatively underutilised methodology in healthcare research can provide more nuanced, yet generalisable, evidence than that available via surveys or small interview studies, and should be used in future research.
RESUMO
BackgroundThe COVID-19 pandemic has had substantial impacts on lives across the globe. Job losses have been widespread, and individuals have experienced significant restrictions on their usual activities, including extended isolation from family and friends. While studies suggest population mental health worsened from before the pandemic, not all individuals appear to have experienced poorer mental health. This raises the question of how people managed to cope during the pandemic. MethodsTo understand the coping strategies individuals employed during the COVID-19 pandemic, we used structural topic modelling, a text mining technique, to extract themes from free-text data on coping from over 11,000 UK adults, collected between 14 October and 26 November 2020. ResultsWe identified 16 topics. The most discussed coping strategy was thinking positively and involved themes of gratefulness and positivity. Other strategies included engaging in activities and hobbies (such as doing DIY, exercising, walking and spending time in nature), keeping routines, and focusing on one day at a time. Some participants reported more avoidant coping strategies, such as drinking alcohol and binge eating. Coping strategies varied by respondent characteristics including age, personality traits and sociodemographic characteristics and some coping strategies, such as engaging in creative activities, were associated with more positive lockdown experiences. ConclusionA variety of coping strategies were employed by individuals during the COVID-19 pandemic. The coping strategy an individual adopted was related to their overall lockdown experiences. This may be useful for helping individuals prepare for future lockdowns or other events resulting in self-isolation. CorrectionDue to an error in the analytical syntax, in an earlier version of this manuscript (posted August 13, 2021), topic labels in Figure 2 were mixed up. This - and the resulting discussion - have now been corrected. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=140 SRC="FIGDIR/small/21262002v2_fig2.gif" ALT="Figure 2"> View larger version (52K): org.highwire.dtl.DTLVardef@62f742org.highwire.dtl.DTLVardef@15748b9org.highwire.dtl.DTLVardef@1678a2borg.highwire.dtl.DTLVardef@a04c58_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 2:C_FLOATNO Association between document topic proportion and participants age (+ 95% confidence intervals). Derived from OLS regression models including adjustment for gender, ethnicity, age, education level, living arrangement, psychiatric diagnosis, long-term physical health conditions, self-isolation status, Big-5 personality traits and keyworker status. C_FIG
RESUMO
BackgroundDuring the COVID-19 pandemic, the UK government has implemented a series of guidelines, rules, and restrictions to change citizens behaviour to tackle the spread of the virus, such as the promotion of face-masks and the imposition of lockdown stay-at-home orders. The success of these measures requires active co-operation on the part of citizens, but compliance has not been complete. Detailed data is required on the factors aiding or hindering compliance with these measures. MethodsTo understand the facilitators and barriers to compliance with COVID-19 guidelines, we used structural topic modelling, a text mining technique, to extract themes from over 26,000 free-text survey responses from 17,500 UK adults, collected between 17 November and 23 December 2020. ResultsThe main factors facilitating compliance were desires to reduce risk to ones self and ones family and friends and to, a lesser extent, the general public. Also of importance were a desire to return to normality, the availability of activities and technological means to contact family and friends, and the ability to work from home. Identified barriers were difficulties maintaining social distancing in public (due to the actions of other people or environmental constraints), the need to provide or receive support from family and friends, social isolation, missing loved one, and mental health impacts, perceiving the risks as low, social pressure to not comply, and difficulties understanding and keep abreast of changing rules. Several of the barriers and facilitators raised were related to participant characteristics. Notably, women were more likely to discuss needing to provide or receive mental health support from friends and family. ConclusionThe results demonstrate an array of factors contribute to compliance with guidelines. Of particular policy importance, the results suggest that government communications that emphasizes the potential risks of COVID-19 and provides simple, consistent guidance on how to reduce the spread of the virus would improve compliance with preventive behaviours.
RESUMO
IntroductionCOVID-19 vaccines do not confer immediate immunity and vaccinated individuals may still be at risk of transmitting the virus. Governments have not exempted vaccinated individuals from behavioural measures to reduce the spread of COVID-19, such as practicing social distancing. However, vaccinated individuals may have reduced compliance with these measures, given lower perceived risks. MethodsWe used monthly panel data from October 2020 - March 2021 in the UK COVID-19 Social Study to assess changes in compliance following vaccination. Compliance was measured with two items on compliance with guidelines in general and compliance with social distancing. We used matching to create comparable groups of individuals by month of vaccination (January, February, or not vaccinated by February) and fixed effects regression to estimate changes in compliance over the study period. ResultsCompliance increased between October 2020 - March 2021, regardless of vaccination status or month of vaccination. There was no clear evidence that vaccinated individuals decreased compliance relative to those who were not yet vaccinated. ConclusionThere was little evidence that sample members vaccinated in January or February reduced compliance after receiving vaccination for COVID-19. Continued monitoring is required as younger individuals receive the vaccine, lockdown restrictions are lifted and individuals receive second doses of the vaccine.
RESUMO
BackgroundGovernments have implemented a range of measure to tackle COVID-19, primarily focusing on changing citizens behaviours in order to lower transmission of the virus. Some policymakers have expressed concern that citizens would not maintain high levels of compliance with these behaviours over the pandemic and would instead exhibit so-called "behavioural fatigue". While the concept has been criticized, there have been few tests of behavioural fatigue using data from the COVID-19 pandemic, and none that have tracked individuals compliance trajectories. MethodsWe used longitudinal data on self-reported compliance from 50,851 adults in the COVID-19 Social Study collected across two waves of the pandemic in the UK (01 April 2020 - 22 February 2021). We modelled typical compliance trajectories using latent growth curve analysis (LGCA) and tested for behavioural fatigue by attempting to identify a set of participants whose compliance decreased substantially over the study period. ResultsWe selected a four-class LGCA solution. Most individuals maintained high levels of compliance over the pandemic and reported similar levels of compliance across the first and second waves. Approximately one in seven participants had decreasing levels of compliance across the pandemic, reporting noticeably lower levels of compliance in the second wave, a pattern compatible with behavioural fatigue. Individuals with declining compliance levels differed from those with consistently high compliance on multiple characteristics, including (young) age, better physical health, lower empathy and conscientiousness and greater general willingness to take risks. ConclusionWhile a minority, not all individuals have maintained high compliance across the pandemic. Decreasing compliance is related to several psychological traits. The results suggest that targeting of behaviour change messages later in the pandemic may be needed to increase compliance.
RESUMO
BackgroundGovernments have implemented a range of measure to tackle COVID-19, primarily focusing on changing citizens behaviours in order to lower transmission of the virus. Few studies have looked at the patterns of compliance with different measures within individuals: whether people comply with all measures or selectively choose some but not others. Such research is important for designing interventions to increase compliance. MethodsWe used cross-sectional data from 20,947 UK adults in the COVID-19 Social Study collected 17 November - 23 December 2020. Self-report compliance was assessed with six behaviours: mask wearing, hand washing, indoor household mixing, outdoor household mixing, social distancing, and compliance with other guidelines. Patterns of compliance behaviour were identified using latent class analysis, and multinomial logistic regression was used to assess demographic, socioeconomic and personality predictors of behaviour patterns. ResultsWe selected a four latent class solution. Most individuals reported similar levels of compliance across the six behaviour measures. High levels of compliance was the modal response. Lower self-reported compliance was related to young age, high risk-taking behaviour, low confidence in government, and low empathy, among other factors. Looking at individual behaviours, mask wearing had the highest level of compliance whilst compliance with social distancing was relatively low. ConclusionResults suggest that individuals choose to comply with all guidelines, rather than some but not others. Strategies to increase compliance should focus on increasing general motivations to comply alongside specifically encouraging social distancing.
RESUMO
Confidence in the central UK Government has declined since the beginning of the COVID-19 pandemic, and while this may be linked to specific government actions to curb the spread of the virus, understanding is still incomplete. Examining public opinion is important, as research suggests that low confidence in government increases the extent of non-compliance with infection-dampening rules (for instance, social distancing); however, the detailed reasons for this association are still unclear. To understand public opinion on the central UK government during COVID-19, we used structural topic modelling, a text mining technique, to extract themes from over 4000 free-text survey responses, collected between 14 October and 26 November 2020. We identified eleven topics, among which were topics related to perceived government corruption and cronyism, complaints about inconsistency in rules and messaging, lack of clear planning, and lack of openness and transparency. Participants reported that elements of the governments approach had made it difficult to comply with guidelines (e.g., changing rules) or were having impacts on mental wellbeing (e.g., inability to plan for the future). Results suggested that consistent, transparent communication and messaging from the government is critical to improving compliance with measures to contain the virus, as well as protecting mental health during health emergencies.
RESUMO
In the absence of a vaccine, governments have focused on behaviour change (e.g. social distancing and enhanced hygiene procedures) to tackle the COVID-19 pandemic. Existing research on the predictors of compliance with pandemic measures has often produced discrepant results. One explanation for this may be that the determinants of compliance are context specific. Understanding whether this is the case is important for designing public health messaging and for evaluating the generalisability of existing research. We used data from the UCL COVID-19 Social Study; a large weekly panel of UK adults from first five months of lockdown in the UK (n = 21,000). We tested whether the extent to which demographic, socio-economic position, personality traits, pro-social motivations, and the living environment predict compliance changed across the pandemic. Low compliance was strongly related to younger age and also to risk attitudes, empathic concern, and high income, among other factors. But the size of some of these associations was larger in later months when less stringent lockdown and household mixing measures were in place, suggesting context-specific effects. The results also showed that compliance fell faster across some groups, suggesting the importance that public health communications adopt a plurality of messages to maximize broad adherence.
RESUMO
In the absence of a vaccine, governments have focused on social distancing, self-isolation, and increased hygiene procedures to reduce the transmission of SARS-CoV-2 (COVID-19). Compliance with these measures requires voluntary cooperation from citizens. Yet, compliance is not complete, and existing studies provide limited understanding of what factors influence compliance; in particular modifiable factors. We use weekly panel data from 51,000 adults across the first three months of lockdown in the UK to identify factors that are related to compliance with COVID-19 guidelines. We find evidence that increased confidence in government to tackle the pandemic is longitudinally related to higher compliance, but little evidence that factors such as mental health and wellbeing, worries about future adversities, and social isolation and loneliness are related to changes in compliance. Our results suggest that to effectively manage the pandemic, governments should ensure that confidence is maintained, something which has not occurred in all countries.
RESUMO
There are concerns that both the experience of adversities during the COVID-19 pandemic and worries about experiencing adversities will have substantial and lasting effects on mental health. One pathway through which both experience of and worries about adversity may impact health is through effects on sleep. We used data from 48,723 UK adults in the COVID-19 Social Study assessed weekly from 01/04/2020-12/05/2020 to study the association between adversities and sleep quality. We studied six categories of adversity including both worries and experiences of: illness with COVID-19, financial difficulty, loss of paid work, difficulties acquiring medication, difficulties accessing food, and threats to personal safety. We used random-effect within-between models to account for all time-invariant confounders. Both the total number of adversity experiences and total number of adversity worries were associated with lower quality sleep. Each additional experience was associated with a 1.16 (95% CI = 1.10, 1.22) times higher odds of poor quality sleep while each additional worry was associated with a 1.20 (95% CI = 1.17, 1.22) times higher odds of poor quality sleep. When considering specific experiences and worries, all worries and experiences were significantly related to poorer quality sleep except experiences relating to employment and finances. Having a larger social network offered some buffering effects on associations but there was limited further evidence of moderation by social or psychiatric factors. Poor sleep may be a mechanism by which COVID-19 adversities are affecting mental health. This highlights the importance of interventions that support adaptive coping strategies during the pandemic.
RESUMO
ImportanceMultiple data sources suggest that COVID-19 is having adverse effects on mental health. But it is vital to understand what is causing this: worries over potential adversities due to the pandemic, or the toll of experiencing adverse events. ObjectiveTo explore the time-varying longitudinal relationship between (i) worries about adversity, and (ii) experience of adversity, and both anxiety and depression and test the moderating role of socio-economic position. DesignLongitudinal cohort study SettingCommunity study ParticipantsA well-stratified sample of UK adults recruited into the UCL COVID -19 Social Study (a panel study collecting data weekly during the Covid-19 pandemic) via a combination of convenience and targeted recruitment. The sample was weighted to population proportions of gender, age, ethnicity, education and geographical location. ExposuresWorries or experiences of adversities during the COVID-19 pandemic OutcomesAnxiety (GAD-7) and depression (PHQ-9) ResultsData were analysed from 41,909 UK adults (weighted data: 51% female, aged 18-99) followed up across 6 weeks (178,430 observations). Using fixed effects regression was used to explore within-person variation over time, cumulative number of worries and experience of adversities were both related to higher levels of anxiety and depression. Number of worries were associated more with anxiety than depression, but number of experiences were equally related to anxiety and depression. Individuals of lower socio-economic position were more negatively affected psychologically by adverse experiences. Conclusions & relevanceMeasures over the first few weeks of lockdown in the UK appear to have been insufficient at reassuring people given we are still seeing clear associations with poor mental health both for cumulative worries and also for a range of specific worries relating to finance, access to essentials, personal safety and COVID-19. Interventions are required that both seek to prevent adverse events (e.g. redundancies) and that reassure individuals and support adaptive coping strategies. Key pointsO_ST_ABSQuestionC_ST_ABSHow do worries over potential adversities due to the COVID-19 pandemic, or the toll of experiencing adverse events affect mental health? FindingsCumulative number of worries and experience of adversities were both related to higher levels of anxiety and depression during COVID-19, especially amongst individuals of lower socio-economic position. MeaningDuring a pandemic, interventions are required that both seek to prevent adverse events (e.g. redundancies) and that reassure individuals and support adaptive coping strategies.
