Compliance with self-isolation and quarantine measures: literature review

Introduction

Since the beginning of the Covid-19 pandemic, self-isolation and quarantine measures have represented a key strategy to contain the spread of the virus. Adherence to these measures is complex. A range of factors can impact whether someone is willing and able to comply, including socio-economic status, knowledge of rules and guidance, beliefs about the pandemic and levels of formal and informal support available. This literature review will explore self-isolation and quarantine regimes both in the UK and internationally, illustrate the factors associated with compliance and examine the approaches that have been deemed effective in influencing it. It will examine literature covering those who test positive, close contacts, and those returning from international travel.

Self-isolation and quarantine policy in Scotland^[1]

Prior to 9^th August in Scotland, anyone with Covid-19 symptoms and a positive test result had to stay at home and self-isolate immediately for 10 full days. This applied also to their household members and those who had been in close contact with the confirmed case, even if they did not have symptoms or tested negative^[2]. Since the 9^th August, self-isolation rules have changed for those who are fully vaccinated, but those who test positive or are not fully vaccinated must continue to isolate.

From 19 July 2021, there have been changes to the guidelines for international travellers. These are based on a traffic light system classifying countries according to their level of risk and taking into account number of cases and/or variants. People are no longer asked to self-isolate if they travel to Scotland from an amber list country and they have been fully vaccinated in the UK, in a EU member state, Iceland, Liechtenstein, Norway, Switzerland, Andorra, Monaco, San Marino or Vatican City, or the USA at least 14 days before their arrival. However, just like arrivals from green list countries, they are still required to provide a negative Covid-19 test result taken in the 3 days before departure, complete a passenger locator form with details of their final destination and book a test within 2 days of arriving in Scotland though the CTM Booking Portal. People not fully vaccinated should still isolate at home or in the place they are staying for 10 days, and book two tests to be taken on day 2 and 8 of their isolation. Together with taking a pre-departure test and completing a passenger locator form, those arriving from a country or area on the red list should book a quarantine hotel package, including 2 Covid-19 tests for days 2 and 8 of their quarantine^[3]. This is a four nations approach and applies also to England^[4], Wales^[5] and Northern Ireland^[6].

Financial support has been put in place for those who need to self-isolate. In Scotland, people may be entitled to a one-off payment of £500 through the Self-Isolation Support Grant^[7]. Further financial support is available and includes crisis grants, help with benefits and with paying bills.

All index and contact cases in Scotland are offered an initial call from their Local Authority when contact is made by Test and Protect. During this call with the Local Authority support needs are identified and the option of up to two follow-up calls to reassess those needs is given. People self-isolating or in quarantine can also call the National Assistance Helpline, which links callers who cannot get the help they need though family, friends and neighbours to their Local Authority and/or organisations providing support for mental health and wellbeing concerns^[8]. Local Authorities can support people with food and medicine delivery, dog walking, befriending services and isolation accommodation if they cannot self-isolate safely at home. Further links to a number of resources are provided by Ready Scotland^[9].

Research questions

This literature review aims to contribute to better understanding the complex range of factors that determine adherence to self-isolation and quarantine regimes, and to identify approaches and lessons learned from a number of settings that may increase compliance rates. The analysis of the literature examined here is based on the following key research questions:

• How does knowledge of Covid-19 and self-isolation/quarantine regulation impact people's compliance?
• What are the financial and practical implications of self-isolation/quarantine regulation?
• Are ethnic and linguistic minorities able to access information and support for self-isolation/quarantine?
• What is the role of the community in promoting adherence to the regulations? And how does sense of belonging to a community affect compliance?
• What is the role played by risk perception and wider attitudes in determining adherence to the guidelines?
• What is the psychological impact of self-isolation/quarantine regimes?
• What are the risks and opportunities of introducing monitoring and enforcement of self-isolation/quarantine rules?