Coronavirus (COVID-19) support study experiences of and compliance with self-isolation: main report

1. Introduction

Self-isolation is a well establised approach in transmissable disease prevention. The primary reasons for asking individuals to self-isolate during the COVID-19 pandemic have been to interrupt the spread of the virus, reduce community transmission and save lives. Scotland's approach to self-isolation, laid out in the Test, Trace, Isolate, Support Strategy^[3] and the Test and Protect Programme^[4] is for those with, or potentially at risk of developing, COVID-19 to be identified and asked to self-isolate, while offering support for them to do so successfully.

Self-isolation refers to the approach under the Test and Protect system whereby individuals are asked to remain at home or in managed isolation (see below) for a period of 10 days from: the onset of symptoms (or longer if the symptoms have not gone), contact from Test and Protect or return from international travel. Those asked to self-isolate should not leave their house/accommodation unless this is solely to get or return a COVID-19 test and should not receive visitors from outside their household. Where possible, those self-isolating should try to maintain physical distancing from others within their household who have not been advised to self-isolate.

In September 2020, SAGE identified an urgent need for better, and regular, data on adherence to self-isolation across the UK^[5],[6] to understand the challenges faced by those asked to undertake self isolation and enable opportunities to improve and develop support for those self-isolating in the future. This research is intended as a response to this, exploring the rate and extent of compliance, as well as exploring experiences of self-isolation.

A successful self-isolation strategy relies on a robust and responsive testing programme to correctly identify individuals who should isolate. Indeed, early and rapid testing is one of the six main tools in the Scottish Government's strategic approach^[7] to the COVID-19 pandemic^[8]. Testing allows for the identification of positive cases to ensure they get the correct care and to help interrupt further transmission. It also offers: protection for those at increased risk of contact, targeted community testing , and is a means of assessing the stress and resilience of essential services in the wider economy, as well as a means of monitoring cases at a population level. As with all aspects of the response to COVID-19, the testing approach has been developed over time in response to changing circumstances, resources and scientific understanding, including expansion of testing centres and increased testing in the community via free at-home lateral flow tests (available from the end of April 2021).

A self-isolation strategy will only be effective if the public are aware of what is required of them during self-isolation. A person can be willing to self-isolate, and be provided with sufficient support to do so, but it is also vital that they understand the detail of what they are being asked to do. Previous studies have underlined the importance of clear guidance and knowledge in enabling individuals to adhere to self-isolation requirements, including an understanding of the rationale behind the approach and its effectiveness^[9]. This research aimed to establish levels of knowledge and understanding of the self-isolation requirement among those asked, by the Test and Protect system, to do so themselves.

It is also important to understand attitudes and experiences of self-isolation, to understand where challenges to compliance based on support for the overall strategy, and/or individual circumstances, may exist. Willingness to adhere to the guidelines and a belief in the validity of the self-isolation approach have an important part to play in any self-isolation strategy. This research aimed to explore the isolation experience for individuals and the degree to which they believe in the strategy as a means of helping prevent the spread of the disease.

For the self-isolation approach to be successful, those asked to self-isolate need not only to be prepared to do so, but also able to within the context of their own personal circumstances. It is recognised that there are many factors and challenges that may make it difficult to adhere to self-isolation, no matter how much an individual intends to or indeed may believe that they are complying. Sufficient support and an awareness of, and access to, such support is an important criterion to helping prevent onward spread of the virus. This research aimed to identify and understand more about the support needs and challenges encountered by those asked to self-isolate. The evidence will inform policies and initiatives related to supporting self-isolation and identify ways in which the support offer could be adapted to help those self-isolating as much as possible in the ways that they as individuals require.

Additionally, it was important that this research explored the level of impact of self-isolation on the lives of those asked to self-isolate and others within their household, including which sub-groups are most likely to be adversely affected and where additional support may be needed.

The introduction of Scotland's mass vaccination programme, which began in December 2020, offers hope for the future and, alongside testing, self-isolation and adherence to FACTS^[10] guidelines, is a key pillar of the Scottish Government's strategy to reduce the transmission of COVID-19 and save lives. As with many aspects of the Scottish Government's reponse to the COVID-19 pandemic, the evidence related to vaccinations is developing over time, with more being learned about the effectiveness of the vaccination programme against COVID-19 and its transmission, the level and duration of immunity offered and recommendations for the deployment of individual vaccinations. As such, the Scottish Government guidance throughout, including in all three waves of the study, has been to continue to follow the self-isolation guidelines, FACTS and current COVID-19 restrictions irrespective of vaccination status. Therefore, understanding the experiences and attitudes of those asked to self-isolate remains vital in understanding how best to support such individuals in the future.

The specific aims of this research were to:

• Measure compliance rates for the survey sample over 3 monthly waves.
• Provide data on the extent of compliance (from full non-compliance to full compliance).
• Measure understanding of isolation guidance.
• Provide in-depth information on the experience of isolation.
• Provide in-depth information on barriers and support to comply.

The combined strength of a large survey of those asked to self-isolate along with in-depth qualitative exploration allows the Scottish Government and its partners to better understand common and distinct experiences, incentives and barriers to compliance, as well how support can be targeted in the best possible way for specific groups.

This knowledge will inform the policy and practices to improve the Test and Protect system and support high levels of compliance that will ultimately ensure that the population of Scotland can be protected. Interim reporting has been provided throughout fieldwork to feed into this policy area on an ongoing basis.^[11]

This research is to be published at a point at which advice and rules around self-isolation are due to change. The findings here remain crucial to understanding the experience of self-isolation and supporting those asked to self-isolate as long as this remains a significant part of the response to the Covid-19 pandemic.