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
This article has been Reviewed by the following groups
Listed in
- Evaluated articles (ScreenIT)
Abstract
Objective: Explore 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. Design: Mixed-methods study; structured survey and follow-up semi-structured interviews. Setting: Communities served by Bristol, North Somerset & South Gloucestershire Clinical Commissioning Group. Participants: 204 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). Results: Receipt 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 or more on the PHQ-9 questionnaire indicating possible depression and 15% scored 10 or more on the GAD-7 questionnaire indicating possible anxiety. Conclusions: This 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.
Article activity feed
-
SciScore for 10.1101/2022.01.05.21268251: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Verbal consent from participants was recorded and a flexible topic guide was used to aid questioning, allowing participants to discuss emerging ideas. Sex as a biological variable not detected. Randomization Structured survey: A random sample of 840 people were contacted by post and invited to take part in the structured survey, stratified by index of multiple deprivation (IMD4; 240 in the lowest quintile and 150 in each of the remaining quintiles (600 in total)). Blinding not detected. Power Analysis not detected. 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 …
SciScore for 10.1101/2022.01.05.21268251: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Verbal consent from participants was recorded and a flexible topic guide was used to aid questioning, allowing participants to discuss emerging ideas. Sex as a biological variable not detected. Randomization Structured survey: A random sample of 840 people were contacted by post and invited to take part in the structured survey, stratified by index of multiple deprivation (IMD4; 240 in the lowest quintile and 150 in each of the remaining quintiles (600 in total)). Blinding not detected. Power Analysis not detected. 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:These limitations should be considered when transferring the results of this study to other populations, or when using these finding to inform future COVID-19 public health policies. Individuals who are CEV are a clinically heterogenous group. For the first COVID-19 lockdown in England this contributed to the difficulties in disseminating shielding advice as well as differing adaptations to that advice. This has been highlighted by other authors, in particular that some more vulnerable patients did not receive appropriate advice in time.27 Future communications should be disseminated promptly, tailored to health conditions, and delivered in a more targeted way with integrated support from healthcare and mental health services. Furthermore, additional work could focus on future adherence to shielding advice and long-term social distancing adaptations, as well as the long-term implications of shielding for mental health and feelings of social identity. Additionally, creating a mechanism for clear communication, integrated with clinical needs, would support patients who are CEV who may need to shield in future pandemics.
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.
-
