Behavioural responses to Covid-19 health certification: a rapid review
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Abstract
Background
Covid-status certification – certificates for those who test negative for the SARS-CoV-2 virus, test positive for antibodies, or who have been vaccinated against SARS-CoV-2 – has been proposed to enable safer access to a range of activities. Realising these benefits will depend in part upon the behavioural and social impacts of certification. The aim of this rapid review was to describe public attitudes towards certification, and its possible impact on uptake of testing and vaccination, protective behaviours, and crime.
Method
A search was undertaken in peer-reviewed databases, pre-print databases, and the grey literature, from 2000 to December 2020. Studies were included if they measured attitudes towards or behavioural consequences of health certificates based on one of three indices of Covid-19 status: test-negative result for current infectiousness, test-positive for antibodies conferring natural immunity, or vaccination(s) conferring immunity.
Results
Thirty-three papers met the inclusion criteria, only three of which were rated as low risk of bias. Public attitudes were generally favourable towards the use of immunity certificates for international travel, but unfavourable towards their use for access to work and other activities. A significant minority was strongly opposed to the use of certificates of immunity for any purpose. The limited evidence suggested that intention to get vaccinated varied with the activity enabled by certification or vaccination (e.g., international travel). Where vaccination is seen as compulsory this could lead to unwillingness to accept a subsequent vaccination. There was some evidence that restricting access to settings and activities to those with antibody test certificates may lead to deliberate exposure to infection in a minority. Behaviours that reduce transmission may decrease upon health certificates based on any of the three indices of Covid-19 status, including physical distancing and handwashing.
Conclusions
The limited evidence suggests that health certification in relation to COVID-19 – outside of the context of international travel – has the potential for harm as well as benefit. Realising the benefits while minimising the harms will require real-time evaluations allowing modifications to maximise the potential contribution of certification to enable safer access to a range of activities.
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SciScore for 10.1101/2021.04.07.21255072: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable 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:Strengths and limitations of the review: This review included 33 studies pertinent to understanding the possible effects of health certification on public behaviour. To the authors’ knowledge it provides the first overview of …
SciScore for 10.1101/2021.04.07.21255072: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable 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:Strengths and limitations of the review: This review included 33 studies pertinent to understanding the possible effects of health certification on public behaviour. To the authors’ knowledge it provides the first overview of studies in this area, with implications for practice and policy. The review was limited both in scope and quality of studies retrieved. The focus was upon the behaviour of general populations and not upon the behaviour of other relevant actors such as employers or those managing or organising venues and events, entry to which may be dependent upon health certificates. The behaviour of these other actors will also be important in realising benefits of health certification to ensure, for example, that measures designed to reduce transmission at a venue – such as physical distancing – are seen as additional and not substitutes for entrants having a health certificate [84]. Few of the studies included in this view were judged to be high quality. The main reasons for being judged low quality were that it was unclear whether there was a non-response bias; like many surveys conducted during the pandemic, most of the studies featured in this rapid review relied heavily on convenience samples which were not representative [85]. Only three of the studies were peer reviewed at the time of this rapid review. While three were available on pre-print servers, most were unlikely to be published in peer reviewed journals and were often released as public opinion surveys....
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.
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