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

  1. Charlotte Robin
  2. Rosy Reynolds
  3. Helen Lambert
  4. Matthew Hickman
  5. G James Rubin
  6. Louise E Smith
  7. Lucy Yardley
  8. Shenghan Cai
  9. Tingting Zhang
  10. Piers Mook
  11. Oliver McManus
  12. Gemma Lasseter
  13. Polly Compston
  14. Sarah Denford
  15. Juan Zhang
  16. Richard Amlôt
  17. Isabel Oliver

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Abstract

Objective

To gain a better understanding of decisions around adherence to self-isolation advice during the first phase of the COVID-19 response in England.

Design

A mixed-methods cross sectional study.

Setting: England

Participants 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).

Results

Of 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.

Conclusions

Measures 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 study

  • Our 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.

  • Results may not be directly generalisable to wider populations or later phases of pandemic response.

  • We 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.

  • The mixed methods approach combined quantitative measures of adherence with an exploration of how and why these decisions were being made in the same people.

  • Our 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.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2022.03.14.22272273: (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.
    RandomizationInterviews: Respondents who consented to interview were randomly selected to take part, stratified by status (case or contact) and index of multiple deprivation (IMD) quintile, based on home postcode.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Analysis: Survey: Analysis used Stata v15.1 (Stata Statistical Software 2017; StataCorp LLC, College Station, TX).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    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:
    Limitations: Our study is based on a distinct sample of people, who were some of the first COVID-19 cases and their contacts in England, during the first phase of the pandemic response. While this enabled us to gather unique insights into experiences of self-isolation during the early stages of a global pandemic, the sample population is not representative of the wider population. During the early phases of the pandemic response, testing and contact tracing focused on returning holiday makers and travellers and their contacts; consequently, the sample population is primarily White British, of a similar age and from more affluent areas. We attempted to mitigate this by recruiting some interview participants from areas of lower IMD to ensure their experiences were included in the study. However, as the majority of our sample population were from more affluent areas, they may have experienced different barriers to adherence, compared with people for whom access to practical and social support may be more challenging. The low response rate will have introduced response bias, and the delay between respondents being asked to isolate and inviting them to take part in the study (up to 6 months) will have resulted in recall bias as participants may not have been able to accurately recall their behaviours during the early stages of the pandemic. Recall may have been particularly challenging during the early stages of the pandemic, where there was so much uncertainty and rapidly changin...

    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

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  2. Version published to 10.1101/2022.03.14.22272273 on medRxiv