Impact of residual risk messaging to reduce false reassurance following test-negative results from asymptomatic coronavirus (SARS-CoV-2) testing: an online experimental study of a hypothetical test
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Abstract
Individuals who receive a negative lateral flow coronavirus test result may misunderstand it as meaning ‘no risk of infectiousness’, giving false reassurance. This experiment tested the impact of adding information to negative test result messages about residual risk and the need to continue protective behaviours.
Design.
4 (residual risk) × 2 (post-test result behaviours) between-subjects design.
Setting.
Online.
Participants
1200 adults from a representative UK sample recruited via Prolific (12–15 March 2021).
Interventions
Participants were randomly allocated to one of eight messages. Residual risk messages were: (1) ‘Your coronavirus test result is negative’ (control); (2) message 1 plus ‘It’s likely you were not infectious when the test was done’ (current NHS Test & Trace (T&T); (3) message 2 plus ‘But there is still a chance you may be infectious’ (elaborated NHS T&T); and (4) message 3 plus infographic depicting residual risk (elaborated NHS T&T+infographic). Each message contained either no additional information or information about the need to continue following guidelines and protective behaviours.
Outcome measures
(1) Proportion understanding residual risk of infectiousness and (2) likelihood of engaging in protective behaviours (scales 1–7).
Results
The control message decreased understanding relative to the current NHS T&T message: 54% versus 71% (Adjusted Odds Ratio (AOR)=0.56 95% CI 0.34 to 0.95, p=0.030). Understanding increased with the elaborated NHS T&T (89%; AOR=3.25 95% CI 1.64 to 6.42, p=0.001) and elaborated NHS T&T+infographic (91%; AOR=5.16 95% CI 2.47 to 10.82, p<0.001) compared with current NHS T&T message. Likelihood of engaging in protective behaviours was unaffected by information (AOR=1.11 95% CI 0.69 to 1.80, χ 2 (1)=0.18, p=0.669), being high ( M= 6.4, SD =0.9) across the sample.
Conclusions
A considerable proportion of participants misunderstood the residual risk following a negative test result. The addition of a single sentence (‘But there is still a chance you may be infectious’) to current NHS T&T wording increased understanding of residual risk.
Trial registration number
OSF: https://osf.io/byfz3/
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SciScore for 10.1101/2021.08.03.21261482: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
Software and Algorithms Sentences Resources Power: The power analyses conducted with G*Power (version 3.1) indicated that a sample of 1095 was needed to test the hypotheses. G*Powersuggested: (G*Power, RRID:SCR_013726)Analysis: Pre-registered analyses were conducted using SPSS (version 27) with a significance level of p<.05. SPSSsuggested: (SPSS, RRID:SCR_002865)Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and weaknesses of the study: This study provides the first experimental evidence that some misunderstand …
SciScore for 10.1101/2021.08.03.21261482: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
Software and Algorithms Sentences Resources Power: The power analyses conducted with G*Power (version 3.1) indicated that a sample of 1095 was needed to test the hypotheses. G*Powersuggested: (G*Power, RRID:SCR_013726)Analysis: Pre-registered analyses were conducted using SPSS (version 27) with a significance level of p<.05. SPSSsuggested: (SPSS, RRID:SCR_002865)Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and weaknesses of the study: This study provides the first experimental evidence that some misunderstand there to be no residual risk of infectiousness following a negative asymptomatic Covid-19 test result, while demonstrating the effectiveness of simple, low-cost interventions to increase understanding. Implementing these interventions would be a valuable step in ensuring that the implications of asymptomatic LFD testing are more often understood by the public. The study has several limitations. First, participants were responding to a hypothetical test result. The interventions would benefit from being tested in a real world setting to check that the increase in understanding is maintained. Second, expectations of engaging in protective behaviours were high. This could have been due to national lockdown restrictions being in place at the time, as in previous studies22,29. As restrictions ease, there might be more variability in the propensity to follow guidelines and more pronounced effects of messaging on behaviour. Third, a quota sample was used. Although it was broadly demographically representative of the UK population, it was limited to internet users and could have been subject to bias30. A quota sample was favoured as it enables rapid data collection and can therefore meet the demands of a crisis31. Participants were randomly allocated to each message, meaning their effects can be experimentally compared and any issues about representativeness are unlikely...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).
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.
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