Behavioural barriers to COVID-19 testing in Australia: Two national surveys to identify barriers and estimate prevalence by health literacy level

  1. Carissa Bonner
  2. Carys Batcup
  3. Julie Ayre
  4. Kristen Pickles
  5. Erin Cvejic
  6. Tessa Copp
  7. Samuel Cornell
  8. Rachael Dodd
  9. Jennifer Isautier
  10. Brooke Nickel
  11. Kirsten McCaffery

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Abstract

Background

COVID-19 testing and contact tracing has been crucial in Australia’s prevention strategy. However, testing for COVID-19 is far from optimal, and behavioural barriers are unknown. Study 1 aimed to identify the range of barriers to testing. Study 2 aimed to estimate prevalence in a nationally relevant sample to target interventions.

Methods

Study 1: National longitudinal COVID-19 survey from April-November 2020. Testing barriers were included in the June survey (n=1369). Open responses were coded using the COM-B framework (capability-opportunity-motivation). Study 2: Barriers from Study 1 were presented to a new nationally representative sample in November to estimate prevalence (n=2869). Barrier prevalence was analysed by health literacy level using Chi square tests.

Results

Study 1: 49% strongly agreed to get tested for symptoms, and 69% would self-isolate. Concern about pain was the top barrier from a provided list (11%), but 32 additional barriers were identified from open responses and coded to the COM-B framework. Study 2: The most prevalent barriers were motivation issues (e.g. don’t believe symptoms are COVID-19: 28%, few local cases: 18%). Capability issues were also common (e.g. not sure symptoms are bad enough: 19%, not sure whether symptoms need testing: 15%). Many barriers were more prevalent amongst people with low compared to high health literacy, including motivation (preference to self isolate: 21% vs 12%, pain: 15% vs 9%) and capability (not sure symptom needs testing: 12% vs 8%, not sure how to test:11% vs 4%).

Conclusion

Even in a health system with free and widespread access to COVID-19 testing, motivation and capability barriers were prevalent issues, particularly for people with lower health literacy. This study highlights the important of diagnosing behaviour barriers to target public health interventions for COVID-19 and future pandemics.

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  1. ScreenIT

    SciScore for 10.1101/2021.08.26.21262649: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Cell Line AuthenticationAuthentication: Health literacy was measured using Chew et al.’s validated Health Literacy Screener20.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: Our initial study only provided a limited list of testing barriers proposed by the NSW Department of Health, but this sample was not representative and did not cover a large number of “other” responses. We addressed this in our second study with a nationally representative sample and a full list of barriers. However, even the second study was not representative of all community groups, particularly those from culturally and linguistically diverse backgrounds which has been identified as a key area of need in Australia. We are currently conducting a separate survey with these groups using interpreters to conduct the survey in preferred languages, as a partnership with Western Sydney Local health District. The findings may not be generalisable to other countries, particularly where COVID-19 prevalence is too high for a test and trace approach to be feasible, and where opportunity issues such as cost or physical access to testing is a problem. However, understanding COVID-19 testing barriers can help all countries better prepare for the next pandemic where a test-trace-isolate system can be used.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.08.26.21262649 on medRxiv