Understanding adherence to self-isolation in the first phase of COVID-19 response
Authors: Robin Charlotte , Reynolds Rosy , Lambert Helen , Hickman Matthew , Rubin G James , Smith Louise E , Yardley Lucy , Cai Shenghan , Zhang Tingting , Mook Piers , McManus Oliver , Lasseter Gemma , Compston Polly , Denford Sarah , Zhang Juan , Amlôt Richard , Oliver Isabel 
Published: March 2022

Objective

To gain a better understanding of decisions around adherence to self-isolation advice during the first phase of the COVID-19 response in England.

Design

A mixed-methods cross sectional study.

Setting: England

Participants COVID-19 cases and contacts who were contacted by Public Health England (PHE) during the first phase of the response in England (January-March 2020).

Results

Of 250 respondents who were advised to self-isolate, 63% reported not leaving home at all during their isolation period, 20% reported leaving only for lower risk activities (dog walking or exercise) and 16% reported leaving for potentially higher risk, reasons (shopping, medical appointments, childcare, meeting family or friends). Factors associated with adherence to never going out included: the belief that following isolation advice would save lives, experiencing COVID-19 symptoms, being advised to stay in their room (rather than just “inside”), having help from outside and having regular contact by text message from PHE. Factors associated with non-adherence included being angry about the advice to isolate, being unable to get groceries delivered and concerns about losing touch with friends and family. Interviews highlighted that a sense of duty motivated people to adhere to isolation guidance and where people did leave their homes, these decisions were based on rational calculations of the risk of transmission – people would only leave their homes when they thought they were unlikely to come into contact with others.

Conclusions

Measures of adherence should be nuanced to allow for the adaptations people make to their behaviour during isolation. Understanding adherence to isolation and associated reasoning during the early stages of the pandemic is an essential part of pandemic preparedness for future emerging infectious diseases.

Strengths and limitations of this study

Our participants were contacted directly by Public Health England during the first three months of the pandemic – the only cohort of cases and contacts who experienced self-isolation during this early phase of the pandemic.

Results may not be directly generalisable to wider populations or later phases of pandemic response.

We classified reasons for leaving the home as higher or lower contact, as a proxy for potential risk of transmission, however further research published since we conducted our research as refined our understanding of transmission risk, highlighting the need for more in-depth research on adherence behaviour and transmission risk.

The mixed methods approach combined quantitative measures of adherence with an exploration of how and why these decisions were being made in the same people.

Our study provides unique insights into self-isolation during the earliest stages of the pandemic, against a background of uncertainty and lack of information that will recur, inevitably, in the face of future pandemic and similar threats.