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Open Access 01-12-2022 | Public Health | Research

Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation

Authors: Gemma Lasseter, Polly Compston, Charlotte Robin, Helen Lambert, Matthew Hickman, Sarah Denford, Rosy Reynolds, Juan Zhang, Shenghan Cai, Tingting Zhang, Louise E. Smith, G James Rubin, Lucy Yardley, Richard Amlôt, Isabel Oliver

Published in: BMC Public Health | Issue 1/2022

Abstract

Background

The national shielding programme was introduced by UK Government at the beginning of the COVID-19 pandemic, with individuals identified as clinically extremely vulnerable (CEV) offered advice and support to stay at home and avoid all non-essential contact. This study aimed to explore the impact and responses of “shielding” on the health and wellbeing of CEV individuals in Southwest England during the first COVID-19 lockdown.

Methods

A two-stage mixed methods study, including a structured survey (7 August—23 October 2020) and semi-structured telephone interviews (26 August—30 September 2020) with a sample of individuals who had been identified as CEV and advised to “shield” by Bristol, North Somerset & South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG).

Results

The survey was completed by 203 people (57% female, 54% > 69 years, 94% White British, 64% retired) in Southwest England identified as CEV by BNSSG CCG. Thirteen survey respondents participated in follow-up interviews (53% female, 40% > 69 years, 100% White British, 61% retired). Receipt of ‘official’ communication from NHS England or General Practitioner (GP) was considered by participants as the legitimate start of shielding. 80% of survey responders felt they received all relevant advice needed to shield, yet interviewees criticised the timing of advice and often sought supplementary information. Shielding behaviours were nuanced, adapted to suit personal circumstances, and waned over time. Few interviewees received community support, although food boxes and informal social support were obtained by some. Worrying about COVID-19 was common for survey responders (90%). Since shielding had begun, physical and mental health reportedly worsened for 35% and 42% of survey responders respectively. 21% of survey responders scored ≥ 10 on the PHQ-9 questionnaire indicating possible depression and 15% scored ≥ 10 on the GAD-7 questionnaire indicating possible anxiety.

Conclusions

This research highlights the difficulties in providing generic messaging that is applicable and appropriate given the diversity of individuals identified as CEV and the importance of sharing tailored and timely advice to inform shielding decisions. Providing messages that reinforce self-determined action and assistance from support services could reduce the negative impact of shielding on mental health and feelings of social isolation.

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National Audit Office, (2021). Protecting and supporting the clinically extremely vulnerable during lockdown. Great Britain: Ministry of Housing, Communities & Local Government, Department of Health & Social Care

Department of Health and Social Care, (2020). Clinically extremely vulnerable receive updated advice tailored to local COVID alert levels. Available from: https://www.gov.uk/government/news/clinically-extremelyvulnerable-receive-updated-advice-tailored-to-local-covid-alert-levels. Accessed Sept 2022.

NHS Digital, (2022). Shielded Patient List. Available from: https://digital.nhs.uk/coronavirus/shielded-patient-list#what-was-the-shielded-patientlist-. Accessed Sept 2022.

Goverment Digital Services, (2021). Guidance: Get support if you’re clinically extremely vulnerable to coronavirus. https://www.gov.uk/. Accessed Dec 2021.

Eraso Y, Hills S. Self-Isolation and Quarantine during the UK's First Wave of COVID-19. A Mixed-Methods Study of Non-Adherence. Int J Environ Res Public Health 2021;18(13). https://doi.org/10.3390/ijerph18137015 [published Online First: 20210630]

Centers for Disease Control and Prevention, (2020). Nonpharmaceutical Interventions (NPIs). Available from: https://www.cdc.gov/nonpharmaceutical-interventions/index.html. Accessed Sept 2022.

European Centre for Disease Prevention and Control, (2021). Non-pharmaceutical interventions against COVID-19. Available from: https://www.ecdc.europa.eu/en/covid-19/prevention-and-control/non-pharmaceutical-interventions. Accessed Sept 2022.

Chen YC, Chang SC, Tsai KS, et al. Certainties and uncertainties facing emerging respiratory infectious diseases: lessons from SARS. J Formos Med Assoc. 2008;107(6):432–42. https://doi.org/10.1016/s0929-6646(08)60150-3.CrossRefPubMedPubMedCentral

Balinska M, Rizzo C. Behavioural responses to influenza pandemics: what do we know? PLoS Curr. 2009;1:Rrn1037. https://doi.org/10.1371/currents.rrn1037 [published Online First: 20090909]

10.

Bell D, Nicoll A, Fukuda K, et al. Non-pharmaceutical interventions for pandemic influenza, national and community measures. Emerg Infect Dis. 2006;12(1):88–94. https://doi.org/10.3201/eid1201.051371.CrossRefPubMed

11.

Teasdale E, Santer M, Geraghty AWA, et al. Public perceptions of non-pharmaceutical interventions for reducing transmission of respiratory infection: systematic review and synthesis of qualitative studies. BMC Public Health. 2014;14(1):589. https://doi.org/10.1186/1471-2458-14-589.CrossRefPubMedPubMedCentral

12.

Margraf J, Brailovskaia J, Schneider S. Adherence to behavioral Covid-19 mitigation measures strongly predicts mortality. PLoS ONE. 2021;16(3):e0249392. https://doi.org/10.1371/journal.pone.0249392[publishedOnlineFirst:2021/03/31].CrossRefPubMedPubMedCentral

13.

Cava MA, Fay KE, Beanlands HJ, et al. The experience of quarantine for individuals affected by SARS in Toronto. Public Health Nurs. 2005;22(5):398–406. https://doi.org/10.1111/j.0737-1209.2005.220504.x.CrossRefPubMed

14.

Hawryluck L, Gold WL, Robinson S, et al. SARS control and psychological effects of quarantine, Toronto. Canada Emerg Infect Dis. 2004;10(7):1206–12. https://doi.org/10.3201/eid1007.030703.CrossRefPubMed

15.

Mak IW, Chu CM, Pan PC, et al. Long-term psychiatric morbidities among SARS survivors. Gen Hosp Psychiatry. 2009;31(4):318–26. https://doi.org/10.1016/j.genhosppsych.2009.03.001[publishedOnlineFirst:20090415].CrossRefPubMedPubMedCentral

16.

Pfefferbaum B, Schonfeld D, Flynn BW, et al. The H1N1 crisis: a case study of the integration of mental and behavioral health in public health crises. Disaster Med Public Health Prep. 2012;6(1):67–71. https://doi.org/10.1001/dmp.2012.2.CrossRefPubMed

17.

Carmassi C, Foghi C, Dell’Oste V, et al. PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic. Psychiatry Res. 2020;292: 113312. https://doi.org/10.1016/j.psychres.2020.113312.CrossRefPubMedPubMedCentral

18.

Cao W, Fang Z, Hou G, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020;287:112934. https://doi.org/10.1016/j.psychres.2020.112934.CrossRefPubMedPubMedCentral

19.

Zhang SX, Wang Y, Rauch A, et al. Unprecedented disruption of lives and work: Health, distress and life satisfaction of working adults in China one month into the COVID-19 outbreak. Psychiatry Res. 2020;288:112958. https://doi.org/10.1016/j.psychres.2020.112958.CrossRefPubMedPubMedCentral

20.

Ministry of Housing Communities & Local Government, (2019). English indices of deprivation 2019 https://www.gov.uk/government/statistics/english-indices-of-deprivation-2019 [accessed Dec 2021].

21.

Kroenke K, Spitzer RL, Williams JB, et al. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345–59. https://doi.org/10.1016/j.genhosppsych.2010.03.006[publishedOnlineFirst:2010/07/17].CrossRefPubMed

22.

Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7. https://doi.org/10.1001/archinte.166.10.1092[publishedOnlineFirst:2006/05/24].CrossRefPubMed

23.

Ashbaugh AR, Houle-Johnson S, Herbert C, et al. Psychometric Validation of the English and French Versions of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5). PLoS ONE. 2016;11(10):e0161645. https://doi.org/10.1371/journal.pone.0161645[publishedOnlineFirst:2016/10/11].CrossRefPubMedPubMedCentral

24.

R Core Team, (2020). A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. [Available from: URL https://www.R-project.org/].

25.

Guest G, Namey EE, Mitchell ML. Collecting Qualitative Data: A Field Manual for Applied Research. 55 City Road 55 City Road, London: SAGE Publications, Ltd, 2013.

26.

Glaser BG, Strauss AL. The discovery of grounded theory: Strategies for qualitative research: Routledge 2017.

27.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa.CrossRef

28.

Glaser BG. The Constant Comparative Method of Qualitative Analysis. Soc Probl. 1965;12(4):436–45. https://doi.org/10.2307/798843.CrossRef

29.

Charmaz K. Constructing grounded theory. London: SAGE Publications Ltd; 2006.

30.

Michie S, West R, Rogers MB, et al. Reducing SARS-CoV-2 transmission in the UK: A behavioural science approach to identifying options for increasing adherence to social distancing and shielding vulnerable people. Br J Health Psychol. 2020;25(4):945–56. https://doi.org/10.1111/bjhp.12428[publishedOnlineFirst:2020/05/20].CrossRefPubMedPubMedCentral

31.

Smith GD, Spiegelhalter D. Shielding from covid-19 should be stratified by risk. BMJ. 2020;369:m2063. https://doi.org/10.1136/bmj.m2063.CrossRefPubMed

32.

Torjesen I. Covid-19: Charities call for clear advice after “utter mess” of shielding texts. BMJ. 2020;369:m2173. https://doi.org/10.1136/bmj.m2173.CrossRefPubMed

33.

Morton K, Towler L, Groot J, et al. Infection control in the home: a qualitative study exploring perceptions and experiences of adhering to protective behaviours in the home during the COVID-19 pandemic. BMJ Open. 2021;11(12):e056161. https://doi.org/10.1136/bmjopen-2021-056161[publishedOnlineFirst:2021/12/03].CrossRefPubMed

34.

Ghio D, Lawes-Wickwar S, Tang MY, et al. What influences people’s responses to public health messages for managing risks and preventing infectious diseases? A rapid systematic review of the evidence and recommendations. BMJ Open. 2021;11(11):e048750. https://doi.org/10.1136/bmjopen-2021-048750.CrossRefPubMedPubMedCentral

35.

Braunack-Mayer AJ, Street JM, Rogers WA, et al. Including the public in pandemic planning: a deliberative approach. BMC Public Health. 2010;10(1):501. https://doi.org/10.1186/1471-2458-10-501.CrossRefPubMedPubMedCentral

36.

Kemper S, Bongers MEJ, Slok ENE, et al. Patient and public engagement in decision-making regarding infectious disease outbreak management: an integrative review. BMJ Glob Health. 2021;6(11):e007340. https://doi.org/10.1136/bmjgh-2021-007340.CrossRefPubMed

37.

Abbas MZ. Public Understanding and Voluntary Responsibility to Mitigate COVID-19 Pandemic: Role of Local Community Organizations in Information Sharing and Health Literacy. Asia Pac J Public Health. 2021;33(4):451–2. https://doi.org/10.1177/10105395211002656[publishedOnlineFirst:2021/03/18].CrossRefPubMed

38.

Barmania S, Reiss MJ. Health promotion perspectives on the COVID-19 pandemic: The importance of religion. Glob Health Promot. 2021;28(1):15–22. https://doi.org/10.1177/1757975920972992[publishedOnlineFirst:2020/11/25].CrossRefPubMed

39.

McKinlay AR, Fancourt D, Burton A. A qualitative study about the mental health and wellbeing of older adults in the UK during the COVID-19 pandemic. BMC Geriatr. 2021;21(1):439. https://doi.org/10.1186/s12877-021-02367-8.CrossRefPubMedPubMedCentral

40.

Santini ZI, Jose PE, York Cornwell E, et al. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. Lancet Public Health. 2020;5(1):e62–70. https://doi.org/10.1016/s2468-2667(19)30230-0[publishedOnlineFirst:2020/01/09].CrossRefPubMed

41.

Yang XY, Peng S, Yang T, et al. Changing trends of mental and behavioral responses and associations during the COVID-19 epidemic in China: a panel study. Health Educ Res. 2021;36(2):151–8. https://doi.org/10.1093/her/cyab012[publishedOnlineFirst:2021/03/17].CrossRefPubMed

42.

Zavlis O, Butter S, Bennett K, et al. How does the COVID-19 pandemic impact on population mental health? A network analysis of COVID influences on depression, anxiety and traumatic stress in the UK population. Psychol Med 2021:1–9. https://doi.org/10.1017/s0033291721000635 [published Online First: 2021/03/17]

43.

Logie CH, Turan JM. How Do We Balance Tensions Between COVID-19 Public Health Responses and Stigma Mitigation? Learning from HIV Research AIDS Behav. 2020;24(7):2003–6. https://doi.org/10.1007/s10461-020-02856-8[publishedOnlineFirst:2020/04/09].CrossRefPubMed

44.

Abrams T, Abbot D. Disability, Deadly Discourse, and Collectivity amid Coronavirus (COVID-19). Scandinavian Journal of Disability Research 2020;22(1):168–74. https://doi.org/10.16993/sjdr.732

45.

Chen B, McNamara DM. Disability Discrimination, Medical Rationing and COVID-19. Asian Bioeth Rev 2020:1–8. https://doi.org/10.1007/s41649-020-00147-x [published Online First: 2020/09/10]

46.

Shevlin M, McBride O, Murphy J, et al. Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic. BJPsych Open. 2020;6(6):e125. https://doi.org/10.1192/bjo.2020.109[publishedOnlineFirst:2020/10/20].CrossRefPubMed

47.

Kaplan RM, Glassman JR, Milstein A. Effects of Mental Health on the Costs of Care for Chronic Illnesses. Psychiatr Serv. 2019;70(11):1013–9. https://doi.org/10.1176/appi.ps.201900098[publishedOnlineFirst:20190805].CrossRefPubMed

48.

Neville FG, Templeton A, Smith JR, et al. Social norms, social identities and the COVID-19 pandemic: Theory and recommendations. Soc Pers Psychol Compass. 2021;15(5):e12596. https://doi.org/10.1111/spc3.12596.CrossRef

49.

Moran-Ellis J, Alexander VD, Cronin A, et al. Triangulation and integration: processes, claims and implications. Qual Res. 2006;6(1):45–59. https://doi.org/10.1177/1468794106058870.CrossRef

50.

Heath L. Triangulation: Methodology. In: Wright JD, editor. International Encyclopedia of the Social & Behavioral Sciences. 2nd ed. Oxford: Elsevier; 2015. p. 639–44.CrossRef

Title: Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation
Authors: Gemma Lasseter
Polly Compston
Charlotte Robin
Helen Lambert
Matthew Hickman
Sarah Denford
Rosy Reynolds
Juan Zhang
Shenghan Cai
Tingting Zhang
Louise E. Smith
G James Rubin
Lucy Yardley
Richard Amlôt
Isabel Oliver
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Public Health
COVID-19
Published in: BMC Public Health / Issue 1/2022
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-022-14368-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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