Psychological factors associated with reporting side effects following COVID-19 vaccination: a prospective cohort study (CoVAccS - wave 3)

ObjectiveTo investigate symptom reporting following the first and second COVID-19 vaccine doses, attribution of symptoms to the vaccine, and factors associated with symptom reporting. MethodsProspective cohort study (T1: 13-15 January 2021, T2: 4-15 October 2021). Participants were aged 18 years or older, living in the UK. Personal, clinical, and psychological factors were investigated at T1. Symptoms were reported at T2. We used logistic regression analyses to investigate associations. ResultsAfter the first COVID-19 vaccine dose, 74.1% (95% CI 71.4% to 76.7%, n=762/1028) of participants reported at least one injection-site symptom, while 65.0% (95% CI 62.0% to 67.9%, n=669/1029) reported at least one other (non-injection-site) symptom. Symptom reporting was associated with being a woman and younger. After the second dose, 52.9% (95% CI 49.8% to 56.0%, n=532/1005) of participants reported at least one injection-site symptom and 43.7% (95% CI 40.7% to 46.8%, n=440/1006) reported at least one other (non-injection-site) symptom. Symptom reporting was associated with having reported symptoms after the first dose, having an illness that put one at higher risk of COVID-19 (non-injection-site symptoms only), and not believing that one had enough information about COVID-19 to make an informed decision about vaccination (injection-site symptoms only). ConclusionsWomen and younger people were more likely to report symptoms from vaccination. People who had reported symptoms from previous doses were also more likely to report symptoms subsequently, although symptom reporting following the second vaccine was lower than following the first vaccine. Few psychological factors were associated with symptom reporting. HighlightsO_LIWe measured symptom reporting and attributions from the COVID-19 vaccines. C_LIO_LIA prospective cohort study was used (T1: January 2021, T2: October 2021). C_LIO_LIWomen and younger people were more likely to report side effects. C_LIO_LISide effects reporting after the first and second dose was strongly associated. C_LI

Parents' intention to vaccinate their child for COVID-19: a cross-sectional survey (CoVAccS - wave 3)

ObjectivesTo investigate UK parents vaccination intention at a time when COVID-19 vaccination was available to some children. Study designData reported are from the second wave of a prospective cohort study. MethodsOnline survey of 270 UK parents (conducted 4-15 October 2021). At this time, vaccination was available to 16- and 17-year-olds and had become available to 12- to 15- year-olds two weeks prior. We asked participants whose child had not yet been vaccinated how likely they were to vaccinate their child for COVID-19. Linear regression analyses were used to investigate factors associated with intention. Parents were also asked for their main reasons behind vaccination intention. Open-ended responses were analysed using content analysis. ResultsParental vaccination intention was mixed (likely: 39.3%, 95% CI 32.8%, 45.7%; uncertain: 33.9%, 27.7%, 40.2%; unlikely: 26.8%, 20.9%, 32.6%). Intention was associated with: parental COVID-19 vaccination status; greater perceived necessity and social norms regarding COVID-19 vaccination; greater COVID-19 threat appraisal; and lower vaccine safety and novelty concerns. In those who intended to vaccinate their child, the main reasons for doing so were to protect the child and others. In those who did not intend to vaccinate their child, the main reason was safety concerns. ConclusionsParent COVID-19 vaccination and psychological factors explained a large percentage of the variance in vaccination intention for ones child. How fluctuating infection rates, more children being vaccinated, and the UKs reliance on vaccination as a strategy to live with COVID-19 may impact parents intention to vaccinate their child requires further study.

Psychosocial factors affecting COVID-19 vaccine uptake in the UK: a prospective cohort study (CoVAccS - wave 3)

BackgroundWe investigated factors associated with COVID-19 vaccine uptake, future vaccination intentions, and changes in beliefs and attitudes over time. MethodsProspective cohort study. 1500 participants completed an online survey in January 2021 (T1, start of vaccine rollout in the UK), of whom 1148 (response rate 76{middle dot}5%) completed another survey in October 2021 (T2, all UK adults offered two vaccine doses). Binary logistic regression analysis was used to investigate factors associated with subsequent vaccine uptake. Content analysis was used to investigate the main reasons behind future vaccine intentions (T2). Changes in beliefs and attitudes were investigated using analysis of variance. FindingsAt T2, 90{middle dot}0% (95% CI 88{middle dot}2%-91{middle dot}7%) of participants had received two doses of a COVID-19 vaccine, 2{middle dot}2% (95% CI 1{middle dot}3%-3{middle dot}0%) had received one dose, and 7{middle dot}4% (95% CI 5{middle dot}9%-8{middle dot}9%) had not been vaccinated. Uptake was associated with higher intention to be vaccinated at T1, greater perceived vaccination social norms, necessity of vaccination, and perceived safety of the vaccine. People who had initiated vaccination reported being likely to complete it, while those who had not yet received a vaccine reported being unlikely to be vaccinated in the future. At T2, participants perceived greater susceptibility to, but lower severity of, COVID-19 (p<0.001), than T1. Perceived safety and adequacy of vaccine information were higher (p<0.001). InterpretationTargeting modifiable beliefs about the safety and effectiveness of vaccination may increase uptake. FundingData collection was funded by a Keele University Faculty of Natural Sciences Research Development award and a Kings COVID Appeal Fund award. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSCOVID-19 vaccination intention was high at the start of the vaccine rollout in the UK. Research suggests that psychosocial factors are associated with vaccine uptake. However, most research on uptake of the COVID-19 vaccine has investigated factors associated with vaccination intention, and used a cross-sectional design. Added value of this studyWe used a prospective cohort study (T1 conducted in January 2021, the start of the UK vaccine rollout; T2 conducted in October 2021, all UK adults offered two vaccine doses) to investigate factors associated with subsequent COVID-19 vaccination. Qualitative data on the main supporting reasons for future vaccination intentions in those partially or not vaccinated were analysed using content analysis. Changes in vaccine beliefs and attitudes (generally and COVID-19 specific) were also analysed. Implications of all the available evidenceIn our sample, more people reported having been vaccinated than had previously reported intending to be vaccinated. Vaccine uptake was strongly associated with previous vaccination intention, perceived social norms of vaccination, and greater perceived necessity and safety of vaccination. Those who had received at least one COVID-19 vaccine reported being likely to complete the schedule, whereas those who had not received a vaccine reported being unlikely to receive a vaccine.

Understanding adherence to self-isolation in the first phase of COVID-19 response

ObjectiveTo gain a better understanding of decisions around adherence to self-isolation advice during the first phase of the COVID-19 response in England. DesignA mixed-methods cross sectional study. Setting: EnglandParticipants COVID-19 cases and contacts who were contacted by Public Health England (PHE) during the first phase of the response in England (January-March 2020). ResultsOf 250 respondents who were advised to self-isolate, 63% reported not leaving home at all during their isolation period, 20% reported leaving only for lower risk activities (dog walking or exercise) and 16% reported leaving for potentially higher risk, reasons (shopping, medical appointments, childcare, meeting family or friends). Factors associated with adherence to never going out included: the belief that following isolation advice would save lives, experiencing COVID-19 symptoms, being advised to stay in their room (rather than just "inside"), having help from outside and having regular contact by text message from PHE. Factors associated with non-adherence included being angry about the advice to isolate, being unable to get groceries delivered and concerns about losing touch with friends and family. Interviews highlighted that a sense of duty motivated people to adhere to isolation guidance and where people did leave their homes, these decisions were based on rational calculations of the risk of transmission - people would only leave their homes when they thought they were unlikely to come into contact with others. ConclusionsMeasures of adherence should be nuanced to allow for the adaptations people make to their behaviour during isolation. Understanding adherence to isolation and associated reasoning during the early stages of the pandemic is an essential part of pandemic preparedness for future emerging infectious diseases. Strengths and limitations of this studyO_LIOur participants were contacted directly by Public Health England during the first three months of the pandemic - the only cohort of cases and contacts who experienced self-isolation during this early phase of the pandemic. C_LIO_LIResults may not be directly generalisable to wider populations or later phases of pandemic response. C_LIO_LIWe classified reasons for leaving the home as higher or lower contact, as a proxy for potential risk of transmission, however further research published since we conducted our research as refined our understanding of transmission risk, highlighting the need for more in-depth research on adherence behaviour and transmission risk. C_LIO_LIThe mixed methods approach combined quantitative measures of adherence with an exploration of how and why these decisions were being made in the same people. C_LIO_LIOur study provides unique insights into self-isolation during the earliest stages of the pandemic, against a background of uncertainty and lack of information that will recur, inevitably, in the face of future pandemic and similar threats. C_LI

Exploring the impact of shielding advice on the health and wellbeing of individuals identified as extremely vulnerable and advised to shield in Southwest England amid the COVID-19 pandemic: A mixed-methods evaluation

ObjectiveExplore the impact and responses to public health advice on the health and wellbeing of individuals identified as clinically extremely vulnerable (CEV) and advised to shield (not leave home for 12 weeks at start of the pandemic) in Southwest England during the first COVID-19 lockdown. DesignMixed-methods study; structured survey and follow-up semi-structured interviews. SettingCommunities served by Bristol, North Somerset & South Gloucestershire Clinical Commissioning Group. Participants204 people (57% female, 54% >69 years, 94% White British, 64% retired) in Southwest England identified as CEV and were advised to shield completed the survey. Thirteen survey respondents participated in follow-up interviews (53% female, 40% >69years, 100% White British, 61% retired). ResultsReceipt of official communication from NHS England or General Practitioner (GP) was considered by participants as the legitimate start of shielding. 80% of survey responders felt they received all relevant advice needed to shield, yet interviewees criticised the timing of advice and often sought supplementary information. Shielding behaviours were nuanced, adapted to suit personal circumstances, and waned over time. Few interviewees received community support, although food boxes and informal social support were obtained by some. Worrying about COVID-19 was common for survey responders (90%). Since shielding had begun, physical and mental health reportedly worsened for 35% and 42% of survey responders respectively. 21% of survey responders scored [≥]10 on the PHQ-9 questionnaire indicating possible depression and 15% scored [≥]10 on the GAD-7 questionnaire indicating possible anxiety. ConclusionsThis research highlights the difficulties in providing generic messaging that is applicable and appropriate given the diversity of individuals identified as CEV and the importance of sharing tailored and timely advice to inform shielding decisions. Providing messages that reinforce self-determined action and assistance from support services could reduce the negative impact of shielding on mental health and feelings of social isolation. O_TEXTBOXStrengths and limitations of this study O_LIThe mixed-methods study examines the experiences of clinically extremely vulnerable (CEV) people at the height of the COVID-19 crisis, immediately after the first lockdown in England. C_LIO_LIThe use of an existing list of individuals identified as needing to "shield" from Bristol, North Somerset & South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG) allowed for access to key patient groups at the height of the crisis. C_LIO_LIFindings may not be applicable to wider CEV populations due to demographic bias. C_LI C_TEXTBOX

A systematic review of observational methods used to quantify personal protective behaviours among members of the public during the COVID-19 pandemic, and the concordance between observational and self-report measures in infectious disease health protection

ObjectivesTo assess the quantity and quality of studies using an observational measure of behaviour during the COVID-19 pandemic, and to narratively describe the association between self-report and observational data for behaviours relevant to controlling an infectious disease outbreak. DesignSystematic review and narrative synthesis of observational studies. Data sourcesWe searched Medline, Embase, PsychInfo, Publons, Scopus and the Public Health England behavioural science LitRep database from inception to 17th September 2021 for relevant studies. Study selectionWe included studies which collected observational data of at least one of three health protective behaviours (hand hygiene, face covering use and maintaining physical distance from others ( social distancing)) during the COVID-19 pandemic. Studies where observational data were compared to self-report data in relation to any infectious disease were also included. Data extraction and synthesisWe evaluated the quality of studies using the NIH quality assessment scale for observational studies, extracted data on sample size, setting and adherence to health protective behaviours, and synthesized results narratively. ResultsOf 27,279 published papers on COVID-19 relevant health protective behaviours that included one or more terms relating to hand hygiene, face covering and social distancing, we identified 48 studies that included an objective observational measure. Of these, 35 assessed face covering use, 17 assessed hand hygiene behaviour and seven assessed physical distancing. The general quality of these studies was good. When expanding the search to all infectious diseases, we included 21 studies that compared observational versus self-report data. These almost exclusively studied hand hygiene. The difference in outcomes was striking, with self-report over-estimating observed adherence by up to a factor of five in some settings. In only four papers did self-report match observational data in any domains. ConclusionsDespite their importance in controlling the pandemic, we found remarkably few studies assessing protective behaviours by observation, rather than self-report, though these studies tended to be of reasonably good quality. Observed adherence tends to be substantially lower than estimates obtained via self-report. Accurate assessment of levels of personal protective behaviour, and evaluation of interventions to increase this, would benefit from the use of observational methods.

Learning about COVID-19 across borders: Public health information and adherence among international travellers to the UK

ObjectivePublic health control measures at borders have long been central to national strategies for the prevention and containment of infectious diseases. Travel was inevitably associated with the rapid global transmission of COVID-19. In the UK, public health authorities took action to reduce risks of travel-associated spread by providing public health information at ports of entry. This study aims to understand individual risk assessment processes, decision making, and adherence to official advice among international travellers; to provide evidence to inform future policy on the presentation of public health information to facilitate safer international travel. Study designThis study is a qualitative study evaluation. MethodSemi-structured interviews were conducted to investigate risk assessment processes, decision making, and adherence to official Public Health England (PHE) advice among travellers. ResultsParticipants regarded official advice as adequate at the time, despite observing differences between the intervention measures implemented in the countries of departure. Participants however also described adopting precautionary measures including self-isolation and the use of face coverings that went beyond official advice, and variability in the extent to which they adhered to guidance on contacting health authorities. Adherence to official guidance was informed by the perceived salience of specific transmission possibilities and containment measures assessed in relation to participants social and institutional environments. ConclusionAnalysis of travellers reported motivations demonstrates that responses to public health advice constitute a proactive process of risk assessment and rationalised decision-making that incorporates consideration of living situation, trust in information sources, correspondence with cultural logics, and willingness to accept potential risk to self and significant others in guiding preventive action. Our findings concerning international passengers understanding of, and compliance with, official advice and mitigation measures provide valuable evidence to inform future policy and we provide recommendations on the presentation of public health information to facilitate safer international travel. Access to a central source of regularly updated official information would help minimise confusion between different national guidelines. Greater attention to the differentiated information needs of diverse groups in creating future public-facing guidance would help to minimise the uncertainties generated by receipt of generic information.

Is my cough a cold or covid? A qualitative study of COVID-19 symptom recognition and attitudes towards testing in the UK

ObjectiveKey to reducing the spread of COVID-19 in the UK is increased use of the NHS Test and Trace (NHSTT) system. This study explored one of the main issues that determine whether people engage with NHSTT, how people understand symptoms that may indicate the presence of COVID-19 and that should trigger a request for a test. MethodsIn this qualitative study, a series of semi-structured telephone interviews were conducted with 40 people (21 members of the general population, 19 students). There was nearly an equal split between male and female participants in both populations. Data were collected between 30 November and 11 December 2020 and explored using thematic analysis. There was substantial similarity in responses for both populations so we combined our results and highlighted where differences were present. ResultsParticipants generally had good knowledge of the main symptoms of COVID-19 (high temperature, new, persistent cough, anosmia) but had low confidence in their ability to differentiate them from symptoms of other illnesses. Attribution of symptoms to COVID-19 was most likely where the symptoms were severe, many symptoms were present, symptoms had lasted for some time and when perceived risk of exposure to infection was high due to previous contact with others. Participants felt encouraged to engage in testing where symptoms were present and had persisted for several days, though many had concerns about the safety of testing centres and the accuracy of test results. Students had mixed feelings about mass asymptomatic testing, seeing it as a way to access a more normal student experience, but also a potential waste of resources. ConclusionsThis study offers novel insights into how people attribute symptoms to COVID-19 and barriers and facilitators to engaging with testing. Participants had positive views of testing, but there is a need to improve not just recognition of each main symptom, but also understanding that even single, mild symptoms may necessitate a test rather than a "wait and see" approach, and to address concerns around test accuracy to increase testing uptake.

COVID-19 vaccination acceptability in the UK at the start of the vaccination programme: a nationally representative cross-sectional survey (CoVAccS wave 2)

AimTo investigate factors associated with intention to have the COVID-19 vaccination following initiation of the UK national vaccination programme. Methods1,500 adults completed an online cross-sectional survey (13th-15th January 2021). Linear regression analyses were used to investigate associations between intention to be vaccinated for COVID-19 and sociodemographic factors, previous influenza vaccination, attitudes and beliefs about COVID-19, attitudes and beliefs about COVID-19 vaccination and vaccination in general. Participants main reasons for likely vaccination uptake/decline were also solicited. Results73.5% of participants (95% CI 71.2%, 75.7%) reported being likely to be vaccinated against COVID-19, 17.3% were unsure (95% CI 15.4%, 19.3%), and 9.3% (95% CI 7.9%, 10.8%) reported being unlikely to be vaccinated. The full regression model explained 69.8% of the variance in intention. Intention was associated with having been/intending to be vaccinated for influenza last winter/this winter, and with stronger beliefs about social acceptability of a COVID-19 vaccine; the need for vaccination; adequacy of information about the vaccine; and weaker beliefs that the vaccine is unsafe. Beliefs that only those at serious risk of illness should be vaccinated and that the vaccines are just a means for manufacturers to make money were negatively associated with vaccination intention. ConclusionsMost participants reported being likely to get the COVID-19 vaccination. COVID-19 vaccination attitudes and beliefs are a crucial factor underpinning vaccine intention. Continued engagement with the public with a focus on the importance and safety of vaccination is recommended.

Factors associated with nonessential workplace attendance during the Covid-19 pandemic in the UK in early 2021: evidence from cross-sectional surveys

Background and aimsWorking from home where possible is important in reducing spread of Covid-19. In early 2021, a quarter of people in England who believed they could work entirely from home reported attending their workplace. To inform interventions to reduce this, this study examined associated factors. MethodsData from the ongoing CORSAIR survey series of nationally representative samples of people in the UK aged 16+ years in January-February 2021 were used. The study sample was 1422 respondents who reported that they could work completely from home. The outcome measure was self-reported workplace attendance at least once during the preceding week. Factors of interest were analysed in three blocks: 1) sociodemographic variables, 2) variables relating to respondents circumstances, and 3) psychological variables. Results26.8% (95%CI=24.5%-29.1%) of respondents reported having attended their workplace at least once in the preceding week. Sociodemographic variables and living circumstances significantly independently predicted non-essential workplace attendance: male gender (OR=1.85,95%CI=1.33-2.58), dependent children in the household (OR=1.65,95%CI=1.17-2.32), financial hardship (OR=1.14,95%CI=1.08-1.21), socio-economic grade C2DE (OR=1.74, 95%CI=1.19-2.53), working in sectors such as health or social care (OR=4.18, 95%CI=2.56-6.81), education and childcare (OR=2.45, 95%CI=1.45-4.14) and key public service (OR=3.78, 95%CI=1.83-7.81), and having been vaccinated (OR=2.08,95%CI=1.33-3.24). ConclusionsNon-essential workplace attendance in the UK in early 2021 during the Covid-19 pandemic was significantly independently associated with a range of sociodemographic variables and personal circumstances. Having been vaccinated, financial hardship, socio-economic grade C2DE, having a dependent child at home, working in certain key sectors were associated with higher likelihood of workplace attendance.

Understanding patterns of adherence to COVID-19 mitigation measures: A qualitative interview study.

In an effort to reduce the spread of COVID-19, the UK government has introduced a series of mitigation measures. The success of these measures in preventing transmission is dependent on adherence, which is currently considered to be low. Evidence highlights the disproportionate impact of mitigation measures on individuals from Black, Asian and minority ethnic (BAME) communities, as well as among those on a low income, and an understanding of barriers to adherence in these populations is needed. In this qualitative study we examined patterns of adherence to mitigation measures and reasons underpinning these behaviors among people on low income and those from BAME communities. Semi-structured interviews were conducted with 20 participants from BAME and low-income White backgrounds. The topic guide was designed to explore how individuals are adhering to social distancing and self-isolation measures during the COVID-19 pandemic, and to explore in detail the reasons underpinning this behavior. Data were analyzed using thematic analysis following which charts were used to help compare concepts within and between participants and develop an understanding of patterns of adherence. Participants were confused by the constantly changing and seemingly contradictory rules and guidance. As a result, decisions were made about how best to protect themselves and their household from COVID-19, and from the detrimental impact of lockdown restrictions. This was not always in line with government advice. We identified three categories of adherence to lockdown measures 1) caution motivated super-adherence 2) risk-adapted partial-adherence and 3) necessity-driven partial-adherence. Decisions about adherence considered potential for exposure to the virus, ability to reduce risk through use of protective measures, and perceived importance of/need for the behavior. This research highlights a need for a more nuanced understanding of adherence to lockdown measures. Provision of practical and financial support could reduce the number of people who have to engage in necessity-driven partial-adherence. Information about viral transmission could help people assess the risk associated with partial-adherence more accurately. More evidence is required on population level risks of people adopting risk-adapted partial-adherence.

Parental perceptions of COVID-19-like illness in their children

ObjectivesTo explore parents perceptions of COVID-19-like symptoms in their child and attitudes towards isolating from others in the household when unwell. Study DesignQualitative, semi-structured interviews. Methods30 semi-structured telephone interviews with parents of children between 4 and 18 years. ResultsWe found four themes relating to symptom attribution ( normalising symptoms, err on the side of caution, experience of temperature, symptoms not normal for us). In general, parents were more likely to attribute symptoms to COVID-19 if a temperature was present or the symptoms were perceived as unusual for their family. Four themes relating to self-isolation ( difficult to prevent contact with children, isolation would be no different to lockdown life, ability to get food and supplies, limited space). Parents believed they would find isolation within the household difficult or impossible if they had dependent children, had limited space or could not shop for groceries. ConclusionsThe findings highlight complexities in symptom perception, attribution, and household isolation. We suggest that they can be overcome by a) providing better guidance on what symptoms require action, b) providing guidance as to how to prevent infection within the household, and c) by supporting families with grocery shopping through a potential second or third wave.

Intention to have the seasonal influenza vaccination during the COVID-19 pandemic among eligible adults in the UK

We investigated likelihood of having the seasonal influenza vaccination in 645 participants who were eligible for the vaccination in the UK. 55.8% indicated they were likely to have the vaccination. Previous research suggests that increasing uptake of the influenza vaccination may help contain a COVID-19 outbreak, so steps need to be taken to convert intention into behaviour and to reach the 23.9% who were unlikely to have the vaccination and the 20.3% who were unsure.

Public health information on COVID-19 for international travellers: Lessons learned from a rapid mixed-method evaluation in the UK containment phase

Introduction In the containment phase of the response to the COVID-19 outbreak, Public Health England (PHE) delivered advice to travellers arriving at major UK ports. We aimed to rapidly evaluate the impact and effectiveness of these communication materials for passengers in the early stages of the pandemic. Methods In stage I (Patient and Public Involvement, PPI) we interviewed seven travellers who had returned from China in January and February 2020. We used these results to develop a questionnaire and topic guides for stage II, a cross-sectional survey and follow-up interviews with passengers arriving at London Heathrow Airport on scheduled flights from China and Singapore. The survey assessed passengers' knowledge of symptoms, actions to take and attitudes towards PHE COVID-19 public health information; interviews explored their views of official public health information and self-isolation. Results In stage II, 121 passengers participated in the survey and 15 in follow-up interviews. 83% of surveyed passengers correctly identified all three COVID-19 associated symptoms listed in PHE information at that time. Most could identify the recommended actions and found the advice understandable and trustworthy. Interviews revealed that passengers shared concerns about the lack of wider official action, and that passengers' knowledge had been acquired elsewhere as much from PHE. Respondents also noted their own agency in choosing to self-isolate, partially as a self-protective measure. Conclusion PHE COVID-19 public health information was perceived as clear and acceptable, but we found that passengers acquired knowledge from various sources and they saw the provision of information alone on arrival as an insufficient official response. Our study provides fresh insights into the importance of taking greater account of diverse information sources and of the need for public assurance in creating public health information materials to address global health threats. Keywords COVID-19, public health advice, government, policy, airport, international travel

Adherence to the test, trace and isolate system: results from a time series of 21 nationally representative surveys in the UK (the COVID-19 Rapid Survey of Adherence to Interventions and Responses study)

Objectives: To investigate rates of adherence to the UKs test, trace and isolate system over time. Design: Time series of cross-sectional online surveys. Setting: Data were collected between 2 March and 5 August 2020. Participants: 42,127 responses from 31,787 people living in the UK, aged 16 years or over, are presented (21 survey waves, n{approx}2,000 per wave). Main outcome measures: Identification of the key symptoms of COVID-19 (cough, high temperature / fever, and loss of sense of smell or taste), self-reported adherence to self-isolation if symptomatic, requesting an antigen test if symptomatic, intention to share details of close contacts, self-reported adherence to quarantine if alerted that you had been in contact with a confirmed COVID-19 case. Results: Only 48.9% of participants (95% CI 48.2% to 49.7%) identified key symptoms of COVID-19. Self-reported adherence to test, trace and isolate behaviours was low (self-isolation 18.2%, 95% CI 16.4% to 19.9%; requesting an antigen test 11.9%, 95% CI 10.1% to 13.8%; intention to share details of close contacts 76.1%, 95% CI 75.4% to 76.8%; quarantining 10.9%, 95% CI 7.8% to 13.9%) and largely stable over time. By contrast, intention to adhere to protective measures was much higher. Non-adherence was associated with: men, younger age groups, having a dependent child in the household, lower socio-economic grade, greater hardship during the pandemic, and working in a key sector. Conclusions: Practical support and financial reimbursement is likely to improve adherence. Targeting messaging and policies to men, younger age groups, and key workers may also be necessary.

COVID-19 vaccination intention in the UK: Results from the COVID-19 Vaccination Acceptability Study (CoVAccS), a nationally representative cross-sectional survey

AimTo investigate factors associated with intention to be vaccinated against COVID-19. MethodsOnline cross-sectional survey of 1,500 UK adults, recruited from an existing online research panel. Data were collected between 14th and 17th July 2020. We used linear regression analyses to investigate associations between intention to be vaccinated for COVID-19 "when a vaccine becomes available to you" and socio-demographic factors, previous influenza vaccination, general vaccine attitudes and beliefs, attitudes and beliefs about COVID-19, and attitudes and beliefs about a COVID-19 vaccination. Results64% of participants reported being likely to be vaccinated against COVID-19; 27% were unsure and 9% reported being unlikely to be vaccinated. Personal and clinical characteristics, previous influenza vaccination, general vaccination beliefs, and beliefs and attitudes about COVID-19 and a COVID-19 vaccination explained 77% of the variance in vaccination intention. Intention to be vaccinated was associated with more positive general COVID-19 vaccination beliefs and attitudes, weaker beliefs that the vaccination would cause side effects or be unsafe, greater perceived information sufficiency to make an informed decision about COVID-19 vaccination, greater perceived risk of COVID-19 to others but not oneself, older age, and having been vaccinated for influenza last winter (2019/20). ConclusionsDespite uncertainty around the details of a COVID-19 vaccination, most participants reported intending to be vaccinated for COVID-19. Actual uptake will likely be lower. Vaccination intention reflects general vaccine beliefs and attitudes. Campaigns and messaging about a COVID-19 vaccination should emphasize the risk of COVID-19 to others and necessity for everyone to be vaccinated.

Adherence to protective measures among health care workers in the UK; a cross-sectional study

Healthcare workers (HCWs) are frontline responders to emergency infectious disease outbreaks such as COVID-19. We investigated factors associated with adherence to personal protective behaviours in UK HCWs during the COVID-19 pandemic using an online cross-sectional survey of 1035 healthcare professionals in the UK. Data were collected between 12th and 16th June 2020. Adjusted logistic regressions were used to separately investigate factors associated with adherence to use of personal protective equipment, maintaining good hand hygiene, and physical distancing from colleagues. 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 adequate PPE resources, receiving training during the pandemic, lower perceived fatalism from COVID-19, higher perceived social norms and higher perceived effectiveness of PPE. Adherence to physical distancing was associated with ones workplace being designed, using markings to facilitate physical distancing and receiving training during the pandemic. There were few associations with adherence to hand hygiene. Findings indicate HCWs should receive training on personal protective behaviours to decrease fatalism over contracting COVID-19 and increase perceived effectiveness of protective measures.

Factors associated with self-reported anxiety, depression, and general health during the UK lockdown; a cross-sectional survey

BackgroundTo investigate factors associated with anxiety, depression, and self-reported general health during "lockdown" due to COVID-19 in the UK. MethodsOnline cross-sectional survey of a nationally-representative sample of 2240 participants living in the UK aged 18 years or over (data collected 6-7 May 2020). Participants were recruited from YouGovs online research panel. OutcomesIn this sample, 21{middle dot}9% (n=458, 95% CI [20{middle dot}1% to 23{middle dot}7%]) reported probable anxiety (scored three or over on the GAD-2); while 23{middle dot}5% (n=494, 95% CI [21{middle dot}7% to 25{middle dot}3]) reported probable depression (scored three or over on the PHQ-2). Poorer mental health was associated with greater financial hardship during the lockdown, thinking that you would lose contact with friends or family if you followed Government measures, more conflict with household members during the lockdown, less sense of community with people in your neighbourhood, and lower perceived effectiveness of Government measures. Females and those who were younger were likely to report higher levels of anxiety and depression. The majority of participants reported their general health as "good" (as measured by the first item of the SF-36). Poorer self-reported general health was associated with psychological distress, greater worry about COVID-19 and markers of inequality. InterpretationRates of self-reported anxiety and depression in the UK during the lockdown were greater than population norms. Reducing financial hardship, promoting social connectedness, and increasing solidarity with neighbours and household members may help ease rifts within the community which are associated with distress, thereby improving mental health. Reducing inequality may also improve general health. RESEARCH IN CONTEXTO_ST_ABSEvidence before this studyC_ST_ABSO_LIQuarantine is associated with adverse psychological outcomes. C_LIO_LIPsychological distress during quarantine is associated with greater financial loss, greater perceived susceptibility to and severity of the illness, and greater frustration and boredom during quarantine. C_LIO_LIMeasures put in place to prevent the spread of COVID-19 have highlighted existing inequalities in society, disproportionally affecting younger people, those in lower-income households, and Black and minority ethnic groups. C_LIO_LIResearch in the UK and other countries indicates that rates of anxiety and depression during restrictions of movement such as "lockdown" measures are higher than population norms. C_LI Added value of this studyO_LIIn this study, 22% of the sample reported anxiety, while 24% reported depression. Normative data indicate that these rates are usually approximately 5% and 7% respectively. C_LIO_LIFactors associated with psychological distress included greater financial hardship, poorer social connectedness, greater conflict within the household and the wider neighbourhood, being female and of younger age. C_LIO_LISelf-reported general health in the sample was "good" on average. Factors associated with poorer self-reported general health included markers of inequality and greater worry about COVID-19. C_LI Implications of all the available evidenceO_LIDecreasing the financial impact of measures put in place to prevent the spread of COVID-19 may help improve mental health. C_LIO_LIInterventions promoting social connectedness in isolated young people and measures that increase household and neighbourhood solidarity may help improve mental health. C_LI

Factors associated with adherence to self-isolation and lockdown measures in the UK; a cross-sectional survey

ObjectivesTo investigate factors associated with adherence to self-isolation and lockdown measures due to COVID-19 in the UK. DesignOnline cross-sectional survey. SettingData were collected between 6th and 7th May 2020. Participants2240 participants living in the UK aged 18 years or over. Participants were recruited from YouGovs online research panel. Main outcome measuresHaving gone out in the last 24 hours in those who reported symptoms of COVID-19 in their household. Having gone out shopping for items other than groceries, toiletries or medicines (non-essentials), and total number of outings, in the last week in those who reported no symptoms of COVID-19 in their household. Results217 people (9.7%) reported that they or someone in their household had symptoms of COVID-19 (cough or high temperature / fever) in the last seven days. Of these people, 75.1% had left the home in the last 24 hours (defined as non-adherent). Factors associated with non-adherence were being male, less worried about COVID-19, and perceiving a smaller risk of catching COVID-19. Adherence was associated with having received help from someone outside your household. Results should be taken with caution as there was no evidence for associations when controlling for multiple analyses. Of people reporting no symptoms in the household, 24.5% had gone out shopping for non-essentials in the last week (defined as non-adherent). Factors associated with non-adherence and with a higher total number of outings in the last week included decreased perceived effectiveness of Government "lockdown" measures, decreased perceived severity of COVID-19, and decreased estimates of how many other people were following lockdown rules. Having received help was associated with better adherence. ConclusionsAdherence to self-isolation is poor. As we move into a new phase of contact tracing and self-isolation, it is essential that adherence is improved. Communications should aim to increase knowledge about actions to take when symptomatic or if you have been in contact with a possible COVID-19 case. They should also emphasise the risk of catching and spreading COVID-19 when out and about and the effectiveness of preventative measures. Using volunteer networks effectively to support people in isolation may promote adherence. WHAT IS ALREADY KNOWN ON THIS TOPICO_LIThe UK Government introduced "lockdown" measures, including physical or social distancing, on 23rd March 2020 due to COVID-19. C_LIO_LIGovernment guidance states that people with symptoms of COVID-19 should not leave their home, also known as self-isolation. C_LIO_LIThere is no research investigating adherence to self-isolation and lockdown measures, or factors associated with self-isolation or lockdown measures in the UK. C_LI WHAT THIS STUDY ADDSO_LIApproximately 10% of participants indicated that they had had symptoms of potential COVID-19 (cough and high temperature / fever) in the last week. Of these participants, 75% had left their home in the last 24 hours. C_LIO_LIFactors associated with non-adherence to self-isolation measures included being male, less worried about COVID-19, and perceiving a smaller risk of catching COVID-19. However, these results should be taken with caution as there was no longer evidence for associations when correcting for multiple analyses. C_LIO_LI25% of people who reported no symptoms in their household reported having gone out shopping for items other than groceries, toiletries or medicines in the last week; this was not allowed by Government guidelines in place at the time of data collection. C_LIO_LIFactors associated with non-adherence to lockdown measures, and increased number of outings in the last week, included decreased perceived effectiveness of Government "lockdown" measures, decreased perceived severity of COVID-19, and decreased estimates of how many other people were following lockdown rules. C_LI

The impact of believing you have had COVID-19 on behaviour: Cross-sectional survey

ObjectivesTo investigate whether people who think they have had COVID-19 are less likely to engage in social distancing measures compared with those who think they have not had COVID-19. DesignOn-line cross-sectional survey. SettingData were collected between 20th and 22nd April. Participants6149 participants living in the UK aged 18 years or over. Main outcome measuresPerceived immunity to COVID-19, self-reported adherence to social distancing measures (going out for essential shopping, nonessential shopping, and meeting up with friends/family; total out-of-home activity), worry about COVID-19 and perceived risk of COVID-19 to oneself and people in the UK. Knowledge that cough and high temperature / fever are the main symptoms of COVID-19. ResultsIn this sample, 1493 people (24.3%) thought they had had COVID-19. Only 245 (4.0%) reported receiving a test result saying they had COVID-19. Reported test results were often incongruent with participants belief that they had had COVID-19. People who believed that they had had COVID-19 were: more likely to agree that they had some immunity to COVID-19; less likely to report adhering to social distancing measures; less worried about COVID-19; and less likely to know that cough and high temperature / fever are two of the most common symptoms of COVID-19. ConclusionsThe number of people in the UK who think they have already had COVID-19 is about twice the rate of current prevalence estimates. People who think that they have had COVID-19 may contribute to transmission of the virus through non-adherence to social distancing measures. Clear communications to this growing group are needed to explain why protective measures continue to be important and to encourage sustained adherence. COPYRIGHTThe Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in BMJ editions and any other BMJPGL products and sublicences such use and exploit all subsidiary rights, as set out in our licence. FUNDING SOURCESJW is funded by a career development fellowship from Cancer Research UK (ref C7492/A17219). LS and GJR are supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at Kings College London in partnership with Public Health England (PHE), in collaboration with the University of East Anglia and Newcastle University. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care, Public Health England. Data collection was funded via a block Government grant to the Behavioural Insights Team. COMPETING INTEREST STATEMENTAll authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: ALM and ME report grants from government partners to the Behavioural Insights Team, during the conduct of the study, JW reports grants from Cancer Research UK, during the conduct of the study; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work. TRANSPARENCY DECLARATIONThe authors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned have been explained. AUTHOR CONTRIBUTION STATEMENTThe study was conceptualised by LS, GJR, JW and TMM. AM and ME completed data collection. LS analysed the data. All authors contributed to, and approved, the final manuscript. WHAT IS ALREADY KNOWN ON THIS TOPICO_LIDuring the COVID-19 pandemic, multiple countries, including the UK, have introduced "lockdown" measures. C_LIO_LIThe World Health Organization has warned against using the results of antibody tests to issue "immunity passports" due to fears that those who test positive for antibodies may stop adhering to protective measures. C_LIO_LIThere is no research investigating adherence to protective measures among those who think they have had COVID-19. C_LI WHAT THIS STUDY ADDSO_LIThis is the first study investigating behavioural differences between those who think they have had COVID-19 and those who do not. C_LIO_LIAbout twice as many people think they have had COVID-19 than prevalence estimates suggest. C_LIO_LIResults suggest that there may be a high degree of self-misdiagnosis within those who think they have had COVID-19. C_LIO_LIThose who think they have had COVID-19 were more likely to think they were immune to COVID-19, and less likely to adhere to social distancing measures. C_LI