A mixed-methods evaluation of advice on isolation and health-seeking to contain transmission
Lead Research Organisation:
Public Health England
Department Name: UNLISTED
Abstract
To help reduce the spread of COVID-19 during the containment phase, people retuning from affected countries and contacts of cases were advised to stay at home and avoid contact with others (self-isolate). In addition, people who were repatriated from affected countries were advised to stay in supported isolation facilities. During the delay phase, additional advice has been issued for anyone with symptoms to self-isolate and the whole population to stay at home and only leave their house if necessary (social distancing). Anyone with underlying health conditions has been advised to self-isolate for 12 weeks, regardless of symptoms.
We know that people do not always follow advice and experiencing isolation can have a negative impact on mental health and wellbeing. We will conduct surveys and interviews to assess whether people follow this advice, what might make following this advice difficult, what can be done to support people who are advised to isolate and the impact of isolation on mental health and wellbeing. We will also explore how UK and Chinese communities have responded to public health advice. Our findings will help with the management of the current COVID-19 outbreak and any future disease outbreaks requiring people to distance themselves from others.
We know that people do not always follow advice and experiencing isolation can have a negative impact on mental health and wellbeing. We will conduct surveys and interviews to assess whether people follow this advice, what might make following this advice difficult, what can be done to support people who are advised to isolate and the impact of isolation on mental health and wellbeing. We will also explore how UK and Chinese communities have responded to public health advice. Our findings will help with the management of the current COVID-19 outbreak and any future disease outbreaks requiring people to distance themselves from others.
Technical Summary
This COVID-19 Rapid Response award is jointly funded (50:50) between the Medical Research Council and the National Institute for Health Research. The figure displayed is the total award amount of the two funders combined, with each partner contributing equally towards the project.
Measures to contain and delay COVID-19 in the UK include supported isolation for repatriated individuals, targeted advice to self-isolate for confirmed cases, contacts and symptomatic people, “shielding” for extremely vulnerable people and social distancing for the rest of the population. Evidence suggests that advice to self-isolate is not always adhered to and experiencing supported or self-isolation can have detrimental effects on mental health and wellbeing. We aim to assess the effectiveness, acceptability and impact of isolation and distancing interventions to strengthen the current management of COVID-19.
We propose to implement a series of mixed-methods evaluations, focusing on supported and self-isolation and social distancing. This includes a rapid evaluation of supported isolation to assess adherence to advice and impact on mental health and wellbeing, using quantitative surveys and semi-structured interviews. We will also evaluate self-isolation and social distancing advice during the containment and delay phases, using a quantitative survey and follow-up interviews with people identified through contact tracing activities, extremely vulnerable “shielded” individuals and the general population, to determine barriers and facilitators to adherence and assess the impact of advice on health and wellbeing, including identifying any differences between the different groups. Finally, an ethnographic study will focus on community responses in the UK and China through a series of narrative interviews and analysis of documentary sources.
We will produce interim and final reports, focusing on policy and practice implications for management of supported isolation facilities, communicating advice to self-isolate and socially distance and the development of a communications strategy.
Measures to contain and delay COVID-19 in the UK include supported isolation for repatriated individuals, targeted advice to self-isolate for confirmed cases, contacts and symptomatic people, “shielding” for extremely vulnerable people and social distancing for the rest of the population. Evidence suggests that advice to self-isolate is not always adhered to and experiencing supported or self-isolation can have detrimental effects on mental health and wellbeing. We aim to assess the effectiveness, acceptability and impact of isolation and distancing interventions to strengthen the current management of COVID-19.
We propose to implement a series of mixed-methods evaluations, focusing on supported and self-isolation and social distancing. This includes a rapid evaluation of supported isolation to assess adherence to advice and impact on mental health and wellbeing, using quantitative surveys and semi-structured interviews. We will also evaluate self-isolation and social distancing advice during the containment and delay phases, using a quantitative survey and follow-up interviews with people identified through contact tracing activities, extremely vulnerable “shielded” individuals and the general population, to determine barriers and facilitators to adherence and assess the impact of advice on health and wellbeing, including identifying any differences between the different groups. Finally, an ethnographic study will focus on community responses in the UK and China through a series of narrative interviews and analysis of documentary sources.
We will produce interim and final reports, focusing on policy and practice implications for management of supported isolation facilities, communicating advice to self-isolate and socially distance and the development of a communications strategy.
People |
ORCID iD |
Publications
Denford S
(2021)
Understanding patterns of adherence to COVID-19 mitigation measures: a qualitative interview study.
in Journal of public health (Oxford, England)
| Description | Citation of Denford S, et al (2020) Preventing within household transmission of COVID-19: Is the provision of accommodation feasible and acceptable? in in at least two SAGE and SPI B papers |
| Geographic Reach | National |
| Policy Influence Type | Citation in other policy documents |
| Impact | The Scientific Advisory Group for Emergencies ( SAGE ) provides ministers and officials with evidence-based scientific advice in emergencies, ensuring government advisers are informed and best-placed to make critical decisions based on a range of credible scientific evidence. |
| Description | Citation of Denford S, et al (2020) Preventing within household transmission of COVID-19: Is the provision of accommodation feasible and acceptable? in in at least two SAGE and SPI B papers |
| Geographic Reach | National |
| Policy Influence Type | Citation in other policy documents |
| Impact | The Scientific Advisory Group for Emergencies ( SAGE ) provides ministers and officials with evidence-based scientific advice in emergencies, ensuring government advisers are informed and best-placed to make critical decisions based on a range of credible scientific evidence. |
| Description | Citation of Smith LE, et al (2020) Factors associated with adherence to self-isolation and lockdown measures in the UK: a cross-sectional survey. Public Health, 187, 41-52 in at least seven SAGE and SPI B papers |
| Geographic Reach | National |
| Policy Influence Type | Citation in other policy documents |
| Impact | The Scientific Advisory Group for Emergencies ( SAGE ) provides ministers and officials with evidence-based scientific advice in emergencies, ensuring government advisers are informed and best-placed to make critical decisions based on a range of credible scientific evidence. |
| Description | Citation of Smith LE, et al (2020) Factors associated with self-reported anxiety, depression, and general health during the UK lockdown; a cross-sectional survey in multiple SAGE and SPI B papers |
| Geographic Reach | National |
| Policy Influence Type | Citation in other policy documents |
| Impact | The Scientific Advisory Group for Emergencies ( SAGE ) provides ministers and officials with evidence-based scientific advice in emergencies, ensuring government advisers are informed and best-placed to make critical decisions based on a range of credible scientific evidence. |
| Description | Contribution to Academy of Medical Sciences report for government |
| Geographic Reach | National |
| Policy Influence Type | Citation in other policy documents |
| Impact | One of our Co-Investigators Lucy Yardley contributed to the Expert Advisory Group, which was established at the request of the Government Chief Scientific Adviser to prepare for winter 2021/2022 and beyond. The EAG produced the report based on discussions and and several of our publications have been cited. This report outlines the key challenges and priorities ahead and provides evidence for how measures can be successfully implemented, including behavioural interventions. |
| URL | https://acmedsci.ac.uk/file-download/4747802 |
| Description | Contribution to The Science and Technology Committee exploring considerations for easing lockdown measures in England and the management of other non-pharmaceutical interventions (James Rubin) |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Impact | Aspects discussed include the role of test, trace and isolate as restrictions are eased, the effect of the vaccination programme and the implications of the evolution of the virus. The Committee also questioned Joint Biosecurity centre officials on the technical annex that is used to calculate the impact that testing, tracing and self-isolation could be having on transmission of the virus. |
| URL | https://committees.parliament.uk/committee/135/science-and-technology-committee-commons/news/139311/... |
| Description | Integration into Test and Trace policy and practice |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Impact | Isabel Oliver is the Senior Medical Advisor to the COVID-19 NHS Test and Trace Programme and the results from the research have been regularly integrated into Test and Trace activities |
| Description | Interim report for Parliamentary group on vulnerable people in pandemics: Effectiveness, acceptability and impact of advice to "shield" as part of the COVID-19 response |
| Geographic Reach | National |
| Policy Influence Type | Implementation circular/rapid advice/letter to e.g. Ministry of Health |
| Impact | Information from surveying patients who were shielding presented to inform future policy conversations |
| Description | Preliminary analysis for PHE Behavioural Science Cell (Impact of testing and daily contact on adherence to self-isolation): Effectiveness, acceptability and impact of advice to self-isolate as part of the COVID-19 response |
| Geographic Reach | National |
| Policy Influence Type | Implementation circular/rapid advice/letter to e.g. Ministry of Health |
| Impact | Integration of study results into public health activities moderating self isolation advice |
| Description | Presentation at APPG on vulnerable groups in the pandemic 4th September 2020 (Isabel Oliver) |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Impact | Results from the research were presented at the APPG, which focused on the lived experience of vulnerable groups shielding through the pandemic and discussed the next steps in the protection of these groups, including prospective changes for the delivery of healthcare. Together with patient groups representatives and Parliamentarians, the group reflected on the impact of Coronavirus on the vulnerable groups and looked into ways to reduce their vulnerability to future pandemics. |
| Description | Presentation to Joint Biosecurity Centre on supported self-isolation (Holly Carter) |
| Geographic Reach | National |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Impact | The JBC aims to provide evidence-based, objective analysis, assessment and advice to inform local and national decision-making in response to COVID-19 outbreaks. |
| Description | Report for DHSC briefing note to government: on supporting self-isolation |
| Geographic Reach | National |
| Policy Influence Type | Implementation circular/rapid advice/letter to e.g. Ministry of Health |
| Impact | Results from report contributed to government decision making regarding supported self isolation following overseas travel |
| Description | Report for DHSC: Rapid evaluation of Public Health England communication material at airports for COVID-19 |
| Geographic Reach | National |
| Policy Influence Type | Implementation circular/rapid advice/letter to e.g. Ministry of Health |
| Impact | Results from report integrated into future DHSC activities disseminating public health information at airports |
| Description | SAGE (James Rubin, Lucy Yardley), SAGE- SPI-B (Richard Amlôt, James Rubin, Louise Smith, Lucy Yardley) , SAGE - SPI-M (James Rubin, Lucy Yardley) and Transmission TWEG (Isabel Oliver) Membership |
| Geographic Reach | National |
| Policy Influence Type | Membership of a guideline committee |
| Impact | The Scientific Advisory Group for Emergencies ( SAGE ) provides ministers and officials with evidence-based scientific advice in emergencies, ensuring government advisers are informed and best-placed to make critical decisions based on a range of credible scientific evidence. |
| URL | https://www.gov.uk/government/publications/scientific-advisory-group-for-emergencies-sage-coronaviru... |
| Description | NHS Bristol, North Somerset and South Gloucestershire CCG |
| Organisation | NHS Bristol, North Somerset and South Gloucestershire CCG |
| Country | United Kingdom |
| Sector | Public |
| PI Contribution | Bristol, North Somerset and South Gloucestershire CCG are project partners for the project component evaluating shielding. The self isolation study group has been able to work with the CCG to facilitate access to relevant data for the study. Subsequently using those data within the study's methodology. Additionally feed back mechanisms to the CCG have been created with results shared in a workshop with the regional Integrated Care Steering Group. |
| Collaborator Contribution | Bristol, North Somerset and South Gloucestershire CCG supported access to relevant patient data. Subsequently they have fed into the analysis process to ensure that the results are directly relevant for their patient group. |
| Impact | A presentation of results was given to the CCG's Integrated Care Steering Group. The results from the study will shortly be published |
| Start Year | 2020 |
| Description | Self-isolation study group |
| Organisation | King's College London |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Public Health England supplies expertise and experience in epidemiology, public health and behavioural science to this project |
| Collaborator Contribution | The team combines expertise and resources from the Health Protection Research Units on Behavioural Science (University of Bristol) and Evaluation and Emergency Preparedness and Response (Kings College London), including mixed methods evaluation, health psychology, behavioural science approaches to optimising interventions, ethnographic expertise and complementary knowledge of medical anthropology and anthropology of transnational mobility. |
| Impact | The study team brings together complementary expertise in epidemiology, anthropology, psychology and sociology. The self isolation study group has worked collaboratively throughout, with bi-weekly coordination meetings, to produce the outputs described in this submission |
| Start Year | 2020 |
| Description | Self-isolation study group |
| Organisation | University of Bristol |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Public Health England supplies expertise and experience in epidemiology, public health and behavioural science to this project |
| Collaborator Contribution | The team combines expertise and resources from the Health Protection Research Units on Behavioural Science (University of Bristol) and Evaluation and Emergency Preparedness and Response (Kings College London), including mixed methods evaluation, health psychology, behavioural science approaches to optimising interventions, ethnographic expertise and complementary knowledge of medical anthropology and anthropology of transnational mobility. |
| Impact | The study team brings together complementary expertise in epidemiology, anthropology, psychology and sociology. The self isolation study group has worked collaboratively throughout, with bi-weekly coordination meetings, to produce the outputs described in this submission |
| Start Year | 2020 |
| Description | BBC interviews (Lucy Yardley) |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | • BBC News: "New app helps protect people looking after loved ones with coronavirus" 7/5/20; "Best practice in keeping coronavirus at bay in the home" 20/5/20; "Why is there, according to research, a substantial proportion of people who are quite prepared to just ignore the rules" 30/9/20 . • BBC Radio 4 Today: "Assessing personal risk for COVID" 4/7/20; "Issues faced by COVID-19 self-isolation" 7/8/20; "Are people following the COVID guidance?" 30/9/20; "What is the messaging to keep people safe over Christmas and during winter" 24/11/20. • BBC Radio 4 PM: "Are Covid lockdown rules getting through to people?" 15/1/21 • BBC Radio 5Live: "Interview about minimising risk and maintaining infection control as lockdown eases" 11/5/20 • BBC News at 10: "Main options for the gradual easing of the lockdown" 27/4/20 • BBC Radio 4 World at One: "How can people across the country be persuaded to get tested and self-isolate?" 3/11/20 • BBC The Andrew Marr Show: "Are people following COVID rules or being complacent?" 18/10/20 • BBC Newsnight: "Is England easing the lockdown safely?" 22/6/20 |
| Year(s) Of Engagement Activity | 2020,2021 |
| URL | https://www.bbc.co.uk/iplayer/episode/m000nplp/the-andrew-marr-show-18102020 |
| Description | Blog in BMJ Opinion Authors include Louise Smith, Lucy Yardley, James Rubin |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | "Should we wave goodbye to the handshake?" The BMJ blog includes comment and opinion from the BMJ's international community of readers, authors, and editors |
| Year(s) Of Engagement Activity | 2020 |
| URL | https://blogs.bmj.com/bmj/2020/03/10/should-we-wave-goodbye-to-the-handshake/ |
| Description | Blog in BMJ Opinion, Authors include Lucy Yardley, Richard Amlôt, Charlotte Robin |
| Form Of Engagement Activity | Engagement focused website, blog or social media channel |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | "How can we involve communities in managing the covid-19 pandemic" aiming to share strategies to enhance community engagement and cooperation during the covid-19 pandemic. The BMJ blog includes comment and opinion from the BMJ's international community of readers, authors, and editors |
| Year(s) Of Engagement Activity | 2020 |
| URL | https://blogs.bmj.com/bmj/2020/03/17/how-can-we-involve-communities-in-managing-the-covid-19-pandemi... |
| Description | ESC Routes Workshop (Juan Zhang) |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | Results from the study were integrated into this collaboration between the Center for Ethics, Society, and Computing (ESC) at the University of Michigan (as part of the ESC ROUTES series), the Chinese-English Keywords Project, and the Rutgers University Center for Chinese Studies. |
| Year(s) Of Engagement Activity | 2021 |
| URL | https://esc.umich.edu/covid-tech-china/ |
| Description | Interview on restrictions at Christmas- Helen Lambert |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Interview on Sky news about relaxation of COVID-19 restrictions at Christmas |
| Year(s) Of Engagement Activity | 2020 |
| Description | Interviews on adherence (Helen Lambert) |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Interview on Today (Radio 4), subsequently repeated on Radio 5 Live, on adherence to government guidelines regarding COVID-19 Interview on Sky News on behaviour in response to REACT-1 round 6 study findings Interview on Sky News Coronavirus rules in England aren't working, scientists say - with 96,000 a day getting COVID. 29/10/20 |
| Year(s) Of Engagement Activity | 2020 |
| URL | https://news.sky.com/story/coronavirus-critical-stage-with-96-000-a-day-getting-covid-19-as-more-str... |
| Description | Media interviews (Lucy Yardley) |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Public/other audiences |
| Results and Impact | Multiple, including: • LBC: "The psychology behind self-isolation" 13/03/20 • Esquire: "What Am I Actually Allowed To Do Now? An Expert Decodes The Coronavirus Lockdown Rules" 11/5/20 • ITV News: "Decision not to adopt Sage advice put UK 'three weeks behind' in Covid fight, member says" 13/10/20 • Times Radio Interview: "Prof Lucy Yardley tells G&T that we should try not to spend more than 15 minutes in a shop - and that we should "take a step back and think" about seeing elderly parents over Christmas." 29/11/20 |
| Year(s) Of Engagement Activity | 2020,2021 |
| URL | https://www.bristol.ac.uk/research/impact/coronavirus/media-coverage/ |
| Description | Presentation for PHE COVID-19 virtual symposium |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | Presentation titled "How can we help encourage adherence to self-isolation and lockdown measures?" by Louise Smith as part of an event updating colleagues on the important scientific work that PHE and HPRUs are leading on, or undertaking in partnership with external colleagues, to support the COVID-19 response and add to the wealth of evidence informing the response to control the spread of the SARS-CoV-2, policy development and support health and social care. |
| Year(s) Of Engagement Activity | 2020 |
| URL | https://www.phe-events.org.uk/hpa/frontend/reg/thome.csp?pageID=396991&eventID=902&CSPCHD=0000010000... |
| Description | Presentation to Bristol, North Somerset and South Gloucestershire Intergrated Care Steering Group |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Presentation by Gemma Lasseter and Polly Compston to Bristol, North Somerset and South Gloucestershire Intergrated Care Steering Group in collaboration with NHS Bristol, North Somerset and South Gloucestershire CCG "COVID-19: A mixed-methods evaluation of advice to shield for individuals identified as extremely vulnerable in South West England" sharing results from cohort of sheilding patients with pratitioners directly involved in their care, |
| Year(s) Of Engagement Activity | 2021 |
| Description | Presentation to Test and Trace |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Professional Practitioners |
| Results and Impact | "Evaluating acceptability and impact of advice to self-isolate and shield: Interim results" (Charlotte Robin) |
| Year(s) Of Engagement Activity | 2020 |
| Description | Various media engagement by Lucy Yardley |
| Form Of Engagement Activity | A press release, press conference or response to a media enquiry/interview |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Public/other audiences |
| Results and Impact | Multiple contributions and quotes in online and print media, including local franchised news outlets and radio stations, local and regional newspapers, national newspapers including The Independent, The Scotsman, The Telegraph and The Guardian, Daily Mail, Daily Mirror, and national news platforms including BBC, Associated Press, MSN, Sky, Yahoo Key pieces: • Multiple outlets: "Sage: The 50 experts who have helped shape the Government's Covid-19 response" 4/5/20 • PA News Interview: Reported in Bristol News as "Bristol's Government advisor explains next stage of coronavirus lockdown" 7/5/20 • Sky News, Daily Mail, Daily Telegraph and Gizmodo: "Leave deliveries for 72 hours to limit risk of virus exposure, experts say" 11/5/20 • Multiple outlets: "Pubs and cinemas to reopen in latest lockdown easing" 23/6/20 • Multiple outlets: "Gove defends police access to Test and Trace data of people told to self-isolate" 18/10/20 • The Guardian / Huffington post / Metro / The Sun: "How To Tweak Your Christmas Plans To Minimise The Spread Of Covid" 15/12/20 • Multiple outlets: "Data suggests activity levels during current lockdown higher than last spring" 11/1/20 • The Guardian: "Everyday Covid mistakes we are all still making" 29/1/21 |
| Year(s) Of Engagement Activity | 2020,2021 |
| URL | https://www.bristol.ac.uk/research/impact/coronavirus/media-coverage/ |
| Description | Webinar for Elizabeth Blackwell Institute Focus Week: COVID-19 |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Regional |
| Primary Audience | Professional Practitioners |
| Results and Impact | Webinar on "Evaluating acceptability and impact of public health advice" as part of a week-long event bringing together researchers at Bristol from different disciplines who have been working on COVID-19. The aim is to share research findings and plans to foster engagement and connection. The event is open to all University of Bristol researchers and NHS colleagues. |
| Year(s) Of Engagement Activity | 2020 |
| URL | http://www.bristol.ac.uk/blackwell/events/2020/ebi-covid-19-week.html |