Feasibility and acceptability of daily testing at school as an alternative to self-isolation following close contact with a confirmed case of COVID-19: a qualitative analysis

  1. Sarah Denford
  2. Lauren Towler
  3. Behiye Ali
  4. Georgia Treneman-Evans
  5. Rachael Bloomer
  6. Tim EA Peto
  7. Bernadette C. Young
  8. Lucy Yardley

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Abstract

Background

Daily testing using a rapid Lateral Flow Device (LFD) has been suggested as an alternative to self-isolation. A randomised trial comparing daily contact testing (DCT) in schools with self-isolation found that SARS-CoV-2 transmission within school was comparable and low in both groups. However, if this approach is to be adopted widely, it is critical that we understand the perspective of those who will be delivering and receiving DCT. The aim of this qualitative process study embedded in the randomised controlled trial (RCT) was to improve understanding of a range of behavioural factors that could influence implementation.

Methods

Interviews were conducted with 63 participants, including staff, students, and parents of students who had been identified as being in close contact with someone with COVID-19. The topic guide explored perceptions of daily testing, understanding of positive and negative test results, and adherence to guidance. Data were analysed using an inductive thematic approach.

Results

Results were organised under three main headings: (1) factors influencing daily testing (2) interpretation of test results (3) behaviour during testing period. Participants recognized that daily testing may allow students to remain in school, which was viewed as necessary for both education and social needs. Whilst some felt safer as a result of daily testing, others raised concerns about safety. Participants did not always understand how to interpret and respond to test results, and although participants reported high levels of adherence to the guidance, improved communications were desired.

Conclusion

Daily testing may be a feasible and acceptable alternative to self-isolation among close contacts of people who test positive. However, improved communications are needed to ensure that all students and parents have a good understanding of the rationale for testing, what test results mean, how test results should be acted on, and how likely students are to test positive following close contact. Support is needed for students and parents of students who have to self-isolate and for those who have concerns about the safety of daily testing.

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  1. Version published to 10.1186/s12889-022-13204-x
  2. ScreenIT

    SciScore for 10.1101/2021.10.05.21264548: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: All participants provided verbal consent/assent prior to taking part in the interview.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Transcripts were then imported into NVivo software and all text was labelled with an initial set of codes.
    NVivo
    suggested: (NVivo, RRID:SCR_014802)

    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:
    Many parents and students had a good understanding of the risks and limitations of daily testing, and the implications for managing the residual risk to others. Our research is consistent with previous qualitative research that also suggested that testing did not increase high risk behaviour [5]. Indeed, in the current study, the majority of participants reported adhering to the guidance or only engaging in low-risk activities, with efforts being made to avoid contact with vulnerable individuals. However, research conducted by the Office for National Statistics found that parents were concerned about the effects of isolation on their child’s mental wellbeing [10], and this could lead to non-adherent behaviour for the sake of the child’s welfare [10]. Similarly, within the current study, breaches of regulations appeared to be the result of an assessment of the dis/advantages of ‘breaking the rules’ in terms of the effect it would have on their child’s mental health, whilst simultaneously attempting to minimise risk as much as possible. Much research has highlighted the detrimental impact of the introduction of infection control measures without sufficient explanation and justification [11]. Within the current study there was evidence of confusion about why behaviours were permitted in some settings and not others, and how to interpret apparently contradictory test results. Without further clarity and explanation, these perceived mixed messages may weaken adherence overtime [11...

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.10.05.21264548 on medRxiv