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ObjectivesIndividuals who receive a negative lateral flow coronavirus (Covid-19) test result may misunderstand it as meaning no risk of infectiousness, giving false reassurance. This experiment tested the impact of adding information to negative test result messages about (a) residual risk and (b) need to continue protective behaviours. Design4 (residual risk) x 2 (post-test result behaviours) between-subjects design. SettingOnline. Participants1200 adults from a representative UK sample recruited via Prolific (12-15 March 2021). InterventionsParticipants were randomly allocated to one of eight messages. Residual risk messages were: 1) Your coronavirus test result is negative (control); 2) Message 1 plus Its likely you were not infectious when the test was done (Current NHS Test & Trace); 3) Message 2 plus But there is still a chance you may be infectious (Elaborated NHS T&T); 4) Message 3 plus infographic depicting residual risk (Elaborated NHS T&T + infographic). Each message contained either no additional information or information about behaviour, i.e. the need to continue following guidelines and protective behaviours. Outcome measures(i) proportion understanding residual risk of infectiousness and (ii) likelihood of engaging in protective behaviours (score range 0-7). ResultsThe control message decreased understanding relative to the current NHS T&T message: 54% vs 71% (AOR=0.37 95% CI [0.22, 0.61], p<.001). Understanding increased with the elaborated NHS T&T (89%; AOR=3.27 95% CI [1.78, 6.02], p<.001) and elaborated NHS T&T + infographic (91%; AOR=4.03 95% CI [2.14, 7.58], p<.001) compared to current NHS T&T message. Likelihood of engaging in protective behaviours was unaffected by information (F(1,1192)=0.43, p=.513), being high (M=6.4, SD=0.9) across the sample. ConclusionsThe addition of a single sentence ( But there is still a chance you may be infectious) to current NHS Test & Trace wording increased understanding of the residual risk of infection. Trial registrationOpen Science Framework: https://osf.io/byfz3/
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The success of mass COVID-19 vaccination campaigns rests on widespread uptake. However, although vaccinations provide good protection, they do not offer full immunity and while they likely reduce transmission of the virus to others, the extent of this remains uncertain. This produces a dilemma for communicators who wish to be transparent about benefits and harms and encourage continued caution in vaccinated individuals but not undermine confidence in an important public health measure. In two large pre-registered experimental studies on quota-sampled UK public participants we investigate the effects of providing transparent communication--including uncertainty--about vaccination effectiveness on decision-making. In Study 1 (n = 2,097) we report that detailed information about COVID-19 vaccines, including results of clinical trials, does not have a significant impact on beliefs about the efficacy of such vaccines, concerns over side effects, or intentions to receive a vaccine. Study 2 (n = 2,217) addressed concerns that highlighting the need to maintain protective behaviours (e.g. social distancing) post-vaccination may lower perceptions of vaccine efficacy and willingness to receive a vaccine. We do not find evidence of this: transparent messages did not significantly reduce perceptions of vaccine efficacy, and in some cases increased perceptions of efficacy. We again report no main effect of messages on intentions to receive a vaccine. The results of both studies suggest that transparently informing people of the limitations of vaccinations does not reduce intentions to be vaccinated but neither does it increase intentions to engage in protective behaviours post-vaccination.
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WHAT IS ALREADY KNOWN ON THIS TOPICO_LITest results indicating the presence of antibodies to SARS-CoV-2 are often referred to as Immunity Passports or Certificates. C_LIO_LIDue to the limitations of such tests, including uncertainty about the duration of immunity conferred by detected antibodies, those receiving results indicating the presence of antibodies retain a risk of becoming infected by SARS-CoV-2. C_LIO_LIIt is unknown whether the use of the terms Immunity Passports or Certificates reduces awareness of the residual risk inherent in an antibody-positive test result and adherence to protective behaviours, thereby increasing risk of transmission. C_LI WHAT THIS STUDY ADDSO_LIUsing the term Immunity - as opposed to Antibody - to describe antibody tests for SARS-CoV-2 more than doubled the proportion who erroneously perceived they would have no risk of catching coronavirus in the future given an antibody-positive test result, from 9.8% for Antibody to 19.1% for Immunity. C_LIO_LIPerceiving no risk of infection with coronavirus given an antibody-positive test result was associated with an intention to wash hands less frequently. C_LIO_LIUsing the terms Passport, Certificate or Test had no significant effect. C_LI ObjectiveTo assess the impact of describing an antibody-positive test result using the terms Immunity and Passport or Certificate, alone or in combination, on perceived risk of becoming infected with SARS-CoV-2 and intention to continue protective behaviours. Design2 x 3 experimental design. SettingOnline with data collected between 28th April and 1st May 2020. Participants1,204 adults registered with a UK research panel. InterventionParticipants were randomised to receive one of six descriptions of an antibody test and results showing SARS-CoV-2 antibodies, differing in the terms used to describe the type of test (Immunity vs Antibody) and the test result (Passport vs Certificate vs Test). Main outcome measuresThe primary outcome was the proportion of participants perceiving no risk of becoming infected with SARS-CoV-2 given an antibody positive test result. Other outcomes include intended changes to frequency of handwashing and physical distancing. ResultsWhen using the term Immunity (vs Antibody), 19.1% of participants [95% CI: 16.1 to 22.5] (vs 9.8% [95% CI: 7.5 to 12.4]) perceived no risk of catching coronavirus at some point in the future given an antibody-positive test result (AOR: 2.91 [95% CI: 1.52 to 5.55]). Using the terms Passport or Certificate - as opposed to Test - had no significant effect (AOR: 1.24 [95% CI: 0.62 to 2.48] and AOR: 0.96 [95% CI: 0.47 to 1.99] respectively). There was no significant interaction between the effects of the test and result terminology. Across groups, perceiving no risk of infection was associated with an intention to wash hands less frequently (AOR: 2.32 [95% CI: 1.25 to 4.28]) but there was no significant association with intended avoidance of physical contact with others outside of the home (AOR: 1.37 [95% CI: 0.93-2.03]). ConclusionsUsing the term Immunity (vs Antibody) to describe antibody tests for SARS-CoV-2 increases the proportion of people believing that an antibody-positive result means they have no risk of catching coronavirus in the future, a perception that may be associated with less frequent handwashing. The way antibody testing is described may have implications for the likely impact of testing on transmission rates. Study registrationOpen Science Framework: https://osf.io/tjw78/files/
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ObjectivesTo investigate whether people who think they have had COVID-19 are less likely to engage in social distancing measures compared with those who think they have not had COVID-19. DesignOn-line cross-sectional survey. SettingData were collected between 20th and 22nd April. Participants6149 participants living in the UK aged 18 years or over. Main outcome measuresPerceived immunity to COVID-19, self-reported adherence to social distancing measures (going out for essential shopping, nonessential shopping, and meeting up with friends/family; total out-of-home activity), worry about COVID-19 and perceived risk of COVID-19 to oneself and people in the UK. Knowledge that cough and high temperature / fever are the main symptoms of COVID-19. ResultsIn this sample, 1493 people (24.3%) thought they had had COVID-19. Only 245 (4.0%) reported receiving a test result saying they had COVID-19. Reported test results were often incongruent with participants belief that they had had COVID-19. People who believed that they had had COVID-19 were: more likely to agree that they had some immunity to COVID-19; less likely to report adhering to social distancing measures; less worried about COVID-19; and less likely to know that cough and high temperature / fever are two of the most common symptoms of COVID-19. ConclusionsThe number of people in the UK who think they have already had COVID-19 is about twice the rate of current prevalence estimates. People who think that they have had COVID-19 may contribute to transmission of the virus through non-adherence to social distancing measures. Clear communications to this growing group are needed to explain why protective measures continue to be important and to encourage sustained adherence. COPYRIGHTThe Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in BMJ editions and any other BMJPGL products and sublicences such use and exploit all subsidiary rights, as set out in our licence. FUNDING SOURCESJW is funded by a career development fellowship from Cancer Research UK (ref C7492/A17219). LS and GJR are supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at Kings College London in partnership with Public Health England (PHE), in collaboration with the University of East Anglia and Newcastle University. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care, Public Health England. Data collection was funded via a block Government grant to the Behavioural Insights Team. COMPETING INTEREST STATEMENTAll authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: ALM and ME report grants from government partners to the Behavioural Insights Team, during the conduct of the study, JW reports grants from Cancer Research UK, during the conduct of the study; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work. TRANSPARENCY DECLARATIONThe authors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned have been explained. AUTHOR CONTRIBUTION STATEMENTThe study was conceptualised by LS, GJR, JW and TMM. AM and ME completed data collection. LS analysed the data. All authors contributed to, and approved, the final manuscript. WHAT IS ALREADY KNOWN ON THIS TOPICO_LIDuring the COVID-19 pandemic, multiple countries, including the UK, have introduced "lockdown" measures. C_LIO_LIThe World Health Organization has warned against using the results of antibody tests to issue "immunity passports" due to fears that those who test positive for antibodies may stop adhering to protective measures. C_LIO_LIThere is no research investigating adherence to protective measures among those who think they have had COVID-19. C_LI WHAT THIS STUDY ADDSO_LIThis is the first study investigating behavioural differences between those who think they have had COVID-19 and those who do not. C_LIO_LIAbout twice as many people think they have had COVID-19 than prevalence estimates suggest. C_LIO_LIResults suggest that there may be a high degree of self-misdiagnosis within those who think they have had COVID-19. C_LIO_LIThose who think they have had COVID-19 were more likely to think they were immune to COVID-19, and less likely to adhere to social distancing measures. C_LI