Examining the role of COVID-19 testing availability on intention to isolate: A Randomized hypothetical scenario
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Abstract
Little information exists on how COVID-19 testing influences intentions to engage in risky behavior. Understanding the behavioral effects of diagnostic testing may highlight the role of adequate testing on controlling viral transmission. In order to evaluate these effects, simulated scenarios were conducted evaluating participant intentions to self-isolate based on COVID-19 diagnostic testing availability and results.
Methods
Participants from the United States were recruited through an online survey platform (Amazon Mechanical Turk) and randomized to one of three hypothetical scenarios. Each scenario asked participants to imagine having symptoms consistent with COVID-19 along with a clinical diagnosis from their physician. However, scenarios differed in either testing availability (testing available v. unavailable) or testing result (positive v. negative test). The primary outcome was intention to engage in high-risk COVID-19 behaviors, measured using an 11-item mean score (range 1–7) that was pre-registered prior to data collection. Multi-variable linear regression was used to compare the mean composite scores between conditions. The randomized survey was conducted between July 23 rd to July 29 th , 2020.
Results
A total of 1400 participants were recruited through a national, online, opt-in survey. Out of 1194 respondents (41.6% male, 58.4% female) with a median age of 38.5 years, participants who had no testing available in their clinical scenario showed significantly greater intentions to engage in behavior facilitating COVID-19 transmission compared to those who received a positive confirmatory test result scenario (mean absolute difference (SE): 0.14 (0.06), P = 0.016), equating to an 11.1% increase in mean score risky behavior intentions. Intention to engage in behaviors that can spread COVID-19 were also positively associated with male gender, poor health status, and Republican party affiliation.
Conclusion
Testing availability appears to play an independent role in influencing behaviors facilitating COVID-19 transmission. Such findings shed light on the possible negative externalities of testing unavailability.
Trial registration
Effect of Availability of COVID-19 Testing on Choice to Isolate and Socially Distance , NCT04459520 , https://clinicaltrials.gov/ct2/show/NCT04459520 .
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SciScore for 10.1101/2021.03.22.21251380: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: This randomized trial was exempted by the UCLA Institutional Review Board.
Consent: Participants were excluded from the main study analysis if they were unable to complete the English language consent form, did not list a proper U.S. zip code, failed any one of the attention check questions in either the pre-test or the main survey, or completed the main survey in under 120 seconds—a threshold determined by the study team after pre-testing 15 college-educated individuals (Supplemental eFigure 3).Randomization This randomized trial was exempted by the UCLA Institutional Review Board. Blinding not detected. Power Analysis The sample size of 1,194 (398 per … SciScore for 10.1101/2021.03.22.21251380: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: This randomized trial was exempted by the UCLA Institutional Review Board.
Consent: Participants were excluded from the main study analysis if they were unable to complete the English language consent form, did not list a proper U.S. zip code, failed any one of the attention check questions in either the pre-test or the main survey, or completed the main survey in under 120 seconds—a threshold determined by the study team after pre-testing 15 college-educated individuals (Supplemental eFigure 3).Randomization This randomized trial was exempted by the UCLA Institutional Review Board. Blinding not detected. Power Analysis The sample size of 1,194 (398 per condition) was chosen so as to provide 80% power to detect the estimated effect size of 0.23, assuming a two-sample t-test and a two-sided significance level of 0.017 (3-fold Bonferroni correction for pairwise comparison of study arms). Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources 2 (http://www.r-project.org). http://www.r-project.orgsuggested: (R Project for Statistical Computing, RRID:SCR_001905)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: There are several limitations to our study. First, survey respondents were recruited using MTurk, an online platform that—while as effective as traditional survey sampling methods— skews towards younger, more well-educated individuals [29]. Thus, our participant cohort cannot be interpreted as a nationally representative sample. Nonetheless, given the current pandemic and the need to minimize viral exposure for both researchers and participants, surveying study participants remotely using a well-established, online platform seemed the most reasonable and ethical means to conduct our study. Study findings may also be limited by the hypothetical nature of the survey design, where we asked participants to imagine how they would react in such a scenario. However, survey scenarios were designed to be easily readable and were repeated on several pages in order to facilitate participant comprehension and immersion (Supplement eFigure 4). To further reduce the number of participants who did not take an appropriate amount of time to imagine the scenario, we restricted analysis to participants who spent at least 2 minutes on the survey and passed all attention checks. External validity of this study is limited by the fact that the study only evaluated behavioral intentions. A large body of prior research has noted that behavioral intentions do not immediately translate to behavioral engagement but are rather attenuated or enhanced by other factors. Nevertheless, behavioral...
Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title NCT04459520 Completed Effect of Availability of COVID-19 Testing on Choice to Isol… 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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