Coronavirus (COVID-19) targeted community testing: national evaluation evidence and insights - final report

3. Attitudes and Behaviours

This section presents findings from Proforma returns on partnership understanding of people's motivations and barriers to take up testing. For motivations, partnerships based their responses mainly on results from exit interviews/questionnaires with attendees carried out at sites or accessible afterwards online. Most relate to ATS. It should be noted that those completing exit questionnaires are likely to be the most engaged and are not of a representative population.

Partnership responses in relation to barriers is based on a mix of exit interviews/questionnaires, community surveys, site staff focus groups, a workplace case study and anecdotal evidence from operational staff.

Although the methods have many limitations we can have reasonable confidence in them due to the consistency of findings across the partnerships for the top 5 motivations and barriers, and similarities to findings in other testing research.

Motivations to get tested

The main motivations to get tested as part of the TCT programme came across as:

• for reassurance;
• to protect others; and
• to find out if they were positive because they had symptoms or had been in contact with a case/suspected case.

These are similar to the findings from an evaluation of asymptomatic testing pathways^[15] and in Scottish Government commissioned polling on testing in general^[16]. The top motivations in the asymptomatic testing evaluation (including findings from TCT) were: for reassurance, to protect others, for practical reasons and because testing is encouraged/ required (reflective of the nature of some of the pathways included). The main motivations in Scottish Government polling have been: for reassurance; to protect others; and as part of regular testing.

The notable difference was the motivation in TCT to "find out if have symptoms/been in contact" which could be a reflection of the inclusion of symptomatic testing in the TCT programme.

A number of other motivations were also highlighted in Proforma returns but to a lesser degree:

• Sent for test by workplace or NHS
• Just wanted a test
• Decided on the spur of the moment
• Checking before meeting people or travel
• To contribute to public health knowledge or work out local rate
• To learn how to use the kit under guidance

Barriers to testing

From Proformas, the main barriers to TCT were identified as:

• Don't see the need;
• Worry about the test itself; and
• Financial concerns, eg as a result of not being able to work.

In March Proformas, more detail was provided on some of the early barriers encountered and the following were raised that relate to "concern around tests/testing":

• Belief that NHS resources are better spent elsewhere
• Fear of infection
• Conflicting messaging of national 'stay at home' versus local 'come and get tested'
• Perception of lack of accuracy of tests
• Concerns re false positives
• Tests are meaningless as could contract COVID-19 the next day

Again there are similarities with what was found from the evaluation of asymptomatic testing pathways and in Scottish Government polling on testing in general. Both also found a perception of not being at risk (aligned to not seeing the need) with polling respondents reporting they were not seeing people, had been vaccinated, did not feel at risk or were generally not worried. The asymptomatic testing evaluation also found a key barrier to be concern about the test (accuracy and discomfort).

The main difference was the emergence of financial concerns as a key barrier in TCT but not in the other sources. This may be indicative of efforts to target particular types of populations known not to be so engaged with testing.

A number of other barriers were also highlighted across both Proforma returns:

• Personal impacts
• Concern about social implications, attending socials
• Impact of testing positive on providing care for others (on family; caring responsibilities)
• Concern about mental wellbeing
• Not being able to access existing support networks

Practical considerations

• Difficulty in isolating at home
• Reluctance to attend alone
• Reluctance to go out
• Not being able to afford to get to the test centre

Public understanding

• Public confusion over testing options and terms; Not sure who is eligible to be tested
• Don't understand the benefits
• Lack of awareness of how to get a test
• Not knowing what help is available
• Unsure if it costs money

Addressing barriers and motivations

In the May Proforma, partnerships were asked how barriers and motivations were being addressed and what communications and engagement have been effective. In summary, partnerships reported taking action to address issues as they arise, such as correcting incorrect information on websites, providing signage when highlighted as a barrier, and monitoring of comments and feedback used to inform messaging. Examples of a range of other actions taken include:

• Development of resources in different languages including videos posted on social media
• Social Media adverts targeted to only those who lived in an area that had a local testing centre or mobile unit
• Use of 'community influencers' - One example was a video with a local Imam
• Ongoing communications & engagement activities, via regular COVID-19 Community Champions Network meetings and via outreach teams able to answer questions raised by local communities/specific groups. COVID-19 Community Champions raise issues on behalf of their own groups/networks during weekly meetings, then either Public Health colleagues respond immediately (including circulating/signposting to relevant sources of information) or appropriate people who can respond attend a subsequent meeting.
• Social media seen as useful for answering queries directly
• Marketing of specific messages to specific groups and targeting specific groups eg at foodbanks. A suggestion was also made to target high rise flats where residents may have mobility problems
• Engagement with third sector groups such as organisations for the blind and deaf blind to disseminate information and use of Voluntary Action groups to help push messaging
• Providing alternative forms of support to help address where people do not qualify for the isolation support payment and ensuring support is included in all messaging
• Offering a suite of testing options to enable people to choose an option that best suits them, eg "universal testing kit delivered to home may suit a young working family whereas attending an ATS might suit a retired person who is unsure how to carry out the test or how to order it"
• Actively promoting community testing to assist with events opening, regarded as one way of advertising the programme but also integrating community testing into everyday life
• Community drop-off service to target harder to reach communities