Why ‘one size fits all’ is not enough when designing COVID-19 immunity certificates for domestic use: a UK-wide cross-sectional online survey

  1. Corina Elena Niculaescu
  2. Isabel Sassoon
  3. Irma Cecilia Landa-Avila
  4. Ozlem Colak
  5. Gyuchan Thomas Jun
  6. Panagiotis Balatsoukas

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Abstract

The present study explored public’s willingness to use COVID-19 immunity certificates across six different domestic scenarios.

Design

Cross-sectional online survey.

Setting

UK representative survey conducted on 3 August 2021.

Participants

534 UK residents over 18 years old.

Interventions

Participants replied to the same set of questions.

Primary and secondary outcome measures

The primary outcome measure was willingness to use immunity certificates across three different domestic settings: (1) visiting the general practitioner (GP) for a non-urgent health issue; (2) dining in a restaurant and (3) attending a performance in a theatre. For each setting two options, one prioritising convenience (option A) and the other privacy (option B), were offered. Our secondary outcome measures were computed indices from items adapted from the Health Belief Model; attitudes towards sharing immunity status with service providers; prior to COVID-19 lifestyle. In addition, we recorded data about respondents’ sociodemographic characteristics.

Results

Respondents were more willing to use immunity certificates that prioritised convenience (92%) , rather than privacy (76%), when visiting their GP . However, privacy was more favourable in the other two settings (dining in a restaurant (84%) and going to a theatre (83%)) compared with convenience (38% and 39% respectively). Personal beliefs about COVID-19 and immunity certificates were associated with variations in willingness to use these across all scenarios. No variations were observed across sociodemographics and lifestyle.

Conclusions

The findings of this survey suggest that there is not one-size-fits-all solution for designing immunity certificates. Immunity certificates are complex sociotechnical systems, any attempt to implement these for domestic use should be tailored to different settings and user needs. The design of certification services requires a more evidence-based approach and further research is needed to understand how different settings, design elements (like convenience or privacy ) and personal beliefs about the pandemic should inform their design.

Article activity feed

  1. Version published to 10.1136/bmjopen-2021-058317
  2. Version published to 10.1101/2021.10.12.21264898v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.10.12.21264898: (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 AnalysisPower calculation: The sample size was chosen pragmatically based on several different approaches, obtaining a minimum sample size between 271 and 1,067 participants, depending on the assumptions.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Some key implications of this study for policy making are the following: Limitations: One of the limitations of our study is that participants were recruited using the online survey platform Prolific. Since surveys administered via this platform are completed online (mobile, PC, tablet etc.) our sample is comprised of people who had the means and capacity to use digital technologies. Other studies investigating people’s perceptions of immunity certificates[13,19,47] or COVID-19 vaccine intentions[27,48–50] found some differences based on gender and ethnicity, which we did not find. This can be explained by the fact that unlike the other cited studies, our survey was focused on six specific hypothetical scenarios of using immunity certificates. Another possible explanation can be attributed to the timing of this survey. At the time our survey took place immunity certificates were being used for international travel, hence access, awareness and familiarity with such services were higher than in previously published studies. Finally, from a methodological point of view the mixed effects model we used assumed that the random effect subsumes the possible effects of gender and ethnicity, as we are looking at responses of the same person. Therefore, both the scope and timing of the present study as well as the mixed effects model used differed from other surveys in this context.

    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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  4. Version published to 10.1101/2021.10.12.21264898v1 on medRxiv