Worry and behaviour at the start of the COVID-19 outbreak: results from three UK surveys

We aimed to describe levels of worry and uptake of behaviours that prevent the spread of infection (respiratory and hand hygiene, distancing) in the UK at the very start of the COVID-19 outbreak and to investigate factors associated with worry and adopting protective behaviours. Three cross-sectional online surveys of UK adults (28 to 30 January, n=2016; 3 to 6 February, n=2002; 10 to 13 February 2020, n=2006) were conducted. We used logistic regressions to investigate associations between outcome measures (worry, respiratory and hand hygiene behaviour, distancing behaviour) and explanatory variables. 19.8% of participants (95% CI 18.8% to 20.8%) were very or extremely worried about COVID-19. People from minoritized ethnic groups were particularly likely to feel worried. 39.9% of participants (95% CI 37.7% to 42.0%) had completed one or more hand or respiratory hygiene behaviours more than usual in the last seven days. Uptake was associated with greater worry, perceived effectiveness of individual behaviours and self-efficacy for engaging in them, and having received more information. 13.7% (95% CI 12.2% to 15.2%) had reduced the number of people they had met. This was associated with greater worry, perceived effectiveness, and self-efficacy. Worry and uptake of protective behaviours were high at the start of the COVID-19 outbreak. A substantial minority reported adopting a behaviour that was not yet part of official guidance (reducing the number of people you met). At the start of novel infectious disease outbreaks, communications should emphasise perceived effectiveness of behaviours and ease with which they can be carried out.</p

How have patterns of social mixing changed during the pandemic? A series of cross-sectional nationally representative surveys

Social mixing contributes to the transmission of SARS-CoV-2. We developed a composite measure for risky social mixing, investigating changes during the pandemic and factors associated with risky mixing. Twenty-eight waves of online nationally representative cross-sectional surveys were used (n=47,933 responses; 14 September 2020 to 10 August 2021). We investigated socio-demographic, contextual and psychological factors associated with engaging in highest risk social mixing at six timepoints. Patterns of social mixing varied over time, broadly in line with changes in restrictions. Engaging in highest risk social mixing was associated with being younger, less worried about COVID-19, perceiving a lower risk of COVID-19, perceiving COVID-19 to be a less severe illness, thinking the risks of COVID-19 were being exaggerated, not agreeing that one’s personal behaviour had an impact on how COVID-19 spreads, and not agreeing that information from the Government about COVID-19 can be trusted. Our composite measure for risky social mixing varied in line with restrictions in place at the time of data collection, providing some validation of the measure. While messages targeting psychological factors may reduce higher risk social mixing, achieving a large change in risky social mixing in a short space of time may necessitate a reimposition of restrictions

How has the emergence of the Omicron SARS-CoV-2 variant of concern influenced worry, perceived risk, and behaviour in the UK? A series of cross-sectional surveys

Objectives: To investigate: changes in beliefs and behaviours following news of the Omicron variant and changes to guidance; understanding of Omicron-related guidance; and factors associated with engaging with protective behaviours. Design: Series of cross-sectional surveys (1 November to 16 December 2021, 5 waves of data collection). / Setting: Online. / Participants: People living in England, aged 16 years or over (n=1622 to 1902 per wave). / Primary and secondary outcome measures: Levels of worry and perceived risk, and engagement with key behaviours (out-of-home activities, risky social mixing, wearing a face covering, and testing uptake). / Results: Beliefs about worry and perceived risk of COVID-19 fluctuated over time, with worry, perceived risk to self and perceived risk to people increasing slightly around the time of the announcement about Omicron. Understanding of the new rules in England was low, with people over-estimating the stringency of the new rules. Rates of wearing a face covering increased over time, as did testing uptake. Meeting up with people from another household decreased around the time of the announcement of Omicron (29 November to 1 December), but then returned to previous levels. Associations with engagement with protective behaviours was investigated using regression analyses. There was no evidence for significant associations between out-of-home activity and worry or perceived risk (COVID-19 generally or Omicron-specific). Engaging in highest risk social mixing and always wearing a face covering in hospitality venues were associated with worry and perceived risk about COVID-19. Always wearing a face covering in shops was associated with having heard more about Omicron. / Conclusions: Almost two years into the COVID-19 outbreak, the emergence of a novel variant of concern only slightly influenced worry and perceived risk. The main protective behaviour (wearing a face covering) promoted by new guidance showed significant re-uptake, but other protective behaviours showed little or no change

Do people with symptoms of an infectious illness follow advice to stay at home? Evidence from a series of cross-sectional surveys in the UK

Objectives: To assess the percentage of people with cough, fever, or loss of taste or smell who had been to work, to shops, socialised or provided care to a vulnerable person in the ten days after developing symptoms. To investigate whether these rates differed according to the type of symptom, what the participant thought the cause of their symptoms was, and whether they had taken a COVID-19 test. / Methods: We analysed data from four online surveys conducted 20 September to 3 November 2021, commissioned via a market research company. Participants were aged over 16 years and lived in the UK. / Results: 498 participants reported one or more symptoms and had not had a positive COVID-19 test. Most employed participants had attended work (51.2% to 56.3% depending on the symptom, 95% CIs 42.2% to 65.6%). Rates of other behaviours ranged from 31.4% (caring for a vulnerable person after developing a cough: 95% CI 24.3% to 38.4%) to 61.5% (shopping for groceries or pharmacy after developing a cough: 95% CI 54.1% to 68.9%). There were no differences according to symptom experienced or what the participant felt might be the cause. People who had taken a COVID-19 test engaged in fewer behaviours than people who had not taken a test. / Conclusion: Most people in the UK with symptoms of an infectious disease are not following advice to stay at home, even if they believe they have an infectious illness. Reducing these rates may require a shift in our national attitude to infectious illnesses

Engagement with protective behaviours in the UK during the COVID-19 pandemic: A series of cross-sectional surveys (the COVID-19 Rapid Survey of Adherence to Interventions and Responses [CORSAIR] study)

Background: Behaviour is key to suppressing the COVID-19 pandemic. Maintaining behaviour change can be difficult. We investigated engagement with hand cleaning, reducing the number of outings, and wearing a face covering over the course of the pandemic. / Methods: We used a series of 64 cross-sectional surveys between 10 February 2020 and 20 January 2022 (n≈2,000 per wave). Surveys investigated uptake of hand cleaning behaviours, out of home activity (England only, n≈1,700 per wave) and wearing a face covering (England only, restricted to those who reported going out shopping in the last week, n≈1,400 per wave). / Results: Reported hand cleaning has been high throughout the pandemic period (85% to 90% of participants consistently reporting washing their hands thoroughly and regularly with soap and water frequently or very frequently). Out of home activity has mirrored the easing and re-introduction of restrictive measures. Total number of outings were higher in the second national lockdown. Wearing a face covering increased steadily between April to August 2020, plateauing until the end of measurement in May 2021, with approximately 80% of those who had been out shopping in the previous week reporting wearing a face covering frequently or very frequently. / Conclusions: Engagement with protective behaviours increased at the start of the pandemic and has remained high since. The greatest variations in behaviour reflected changes to Government rules. Despite the duration of restrictions, people have continued to adopt personal protective behaviours that were intended to prevent the spread of COVID-19

Holding a stigmatising attitude at the start of the COVID-19 outbreak (the COVID-19 Rapid Survey of Adherence to Interventions and Responses [CORSAIR] study)

Objectives: To identify the prevalence of a stigmatising attitude towards people of Chinese origin at the start of the COVID-19 outbreak in the UK population and investigate factors associated with holding the stigmatising attitude. Design: Online cross-sectional survey conducted 10 to 13 February 2020 (n=2006, people aged 16 years or over and living in the UK). / Methods: We asked participants to what extent they agreed it was best to avoid areas heavily populated by Chinese people because of the COVID-19 outbreak. Survey materials also asked about: worry, perceived risk, knowledge, information receipt, and perception of government response to COVID-19, and personal characteristics. We ran binary logistic regressions to investigate associations between holding a stigmatising attitude, personal characteristics, and psychological and contextual factors. / Results: 26.1% people (95% CI 24.2% to 28.0%, n=524/2006) agreed it was best to avoid areas heavily populated by Chinese people. Holding a stigmatising attitude was associated with greater worry about COVID-19, greater perceived risk of COVID-19, and poorer knowledge about COVID-19. / Conclusions: At the start of the COVID-19 pandemic, a large percentage of the UK public endorsed avoiding areas in the UK heavily populated by people of Chinese origin. This attitude was associated with greater worry about, and perceived risk of, the COVID-19 outbreak as well as poorer knowledge about COVID-19. At the start of future novel infectious disease outbreaks, proactive communications from official sources should provide context and facts to reduce uncertainty and challenge stigmatising attitudes, to minimise harms to affected communities

Do members of the public think they should use lateral flow tests or PCR tests when they have COVID-19-like symptoms?

Objectives: This study aimed to investigate public use of lateral flow tests (LFT) and polymerase chain reaction (PCR) tests when experiencing key COVID-19 symptoms. Study design: In this study, data from two waves of a cross-sectional nationally representative online survey (data collected 1 and 2 June, and 14 and 15 June 2021; n = 3665 adults aged ≥18 years living in England or Scotland) were used. / Methods: We report data investigating which type of test, if any, the public think Government guidance asks people to use if they have COVID-19 symptoms. In people with key COVID-19 symptoms (high temperature / fever; new, continuous cough; loss of sense of smell; loss of taste), we also describe the uptake of testing, if any. / Results: Ten percent of respondents thought Government guidance stated that they should take an LFT if symptomatic, whereas 18% of people thought that they should take a PCR test; 60% of people thought they should take both types of test (12% did not select either option). In people who were symptomatic, 32% reported taking a test to confirm whether they had COVID-19. Of these, 53% reported taking a PCR test and 44% reported taking an LFT. / Conclusions: Despite Government guidance stating that anyone with key COVID-19 symptoms should complete a PCR test, a significant percentage of the population use LFT tests when symptomatic. Communications should emphasise the superiority of, and need for, PCR tests in people with symptoms

Psychological wellbeing in the English population during the COVID-19 pandemic: a series of cross-sectional surveys

Psychological distress has been elevated during the COVID-19 pandemic. However, few studies published to date have investigated distress after the first wave of infections (Spring – Summer 2020). We investigated distress and wellbeing between April 2020 and September 2021 in England through a series of cross-sectional nationally representative online surveys. People aged 16 years or over living in the UK were eligible for the surveys; for this study we selected only those living in England due to differences in restrictions between UK nations. Distress was measured using the PHQ4 (n=46,478 responses), while wellbeing was measured using the Short Warwick-Edinburgh Mental Wellbeing Scale (n=48,193 responses). Throughout, approximately 50% to 60% of women and 40% to 50% of men reported distress, higher than the 20% to 25% of men, and 25% to 30% of women reported in data. Wellbeing was also worse than population norms, with women reporting lower wellbeing than men. Rates of distress in the English population have been consistently high throughout the pandemic. Patterns of distress have broadly mirrored the pattern of restrictions and case numbers, but there are notable exceptions which indicate that other factors may play a part in population mental health

Tiered restrictions for COVID-19 in England: knowledge, motivation to adhere and self-reported behaviour

Objectives: To test whether public knowledge and confidence in one’s understanding of the local restrictions, motivation to adhere, and self-reported behaviour differed according to tier level. / Design: Cross-sectional nationally representative online survey of 1728 participants living in England (data collection: 26 to 28 October 2020). / Methods: We conducted logistic regression analyses to investigate whether knowledge of restrictions, confidence in knowledge of restrictions, motivation to adhere to restrictions, and self-reported behaviour were associated with personal characteristics and tier. / Results: Between 81% (tier 2) and 89% (tier 3) of participants correctly identified which tier they lived in. Knowledge of specific restrictions was variable. 73% were confident they understood which tier was in place in their local area, while 71% were confident they understood the guidance in their local area. Confidence was associated with being older and living in a less deprived area. 73% were motivated to adhere to restrictions imposed for their local area. Motivation was associated with being female and older. People living in tiers with greater restrictions were less likely to report going out to meet people from another household; reported rates of going out for exercise and for work did not differ. / Conclusions: While recognition of local tier level was high, knowledge of specific guidance for tiers was variable. There was some indication that nuanced guidance (e.g. behaviour allowed in some settings but not others) was more poorly understood than guidance which was absolute (i.e. behaviour is either allowed or not allowed)