Public health information on COVID-19 for international travellers: Lessons learned from a rapid mixed-method evaluation in the UK containment phase
Authors: Zhang Tinting , Robin Charlotte , Cai Shenghan , Sawyer Clare , Rice Wendy , Smith Louise E. , Amlôt Richard , Rubin G. James , Reynolds Rosy , Yardley Lucy , Hickman Matthew , Oliver Isabel , Lambert Helen 
Published: September 2020

AbstractIntroductionIn the containment phase of the response to the COVID-19 outbreak, Public Health England (PHE) delivered advice to travellers arriving at major UK ports. We aimed to rapidly evaluate the impact and effectiveness of these communication materials for passengers in the early stages of the pandemic.MethodsIn stage I (Patient and Public Involvement, PPI) we interviewed seven travellers who had returned from China in January and February 2020. We used these results to develop a questionnaire and topic guides for stage II, a cross-sectional survey and follow-up interviews with passengers arriving at London Heathrow Airport on scheduled flights from China and Singapore. The survey assessed passengers’ knowledge of symptoms, actions to take and attitudes towards PHE COVID-19 public health information; interviews explored their views of official public health information and self-isolation.ResultsIn stage II, 121 passengers participated in the survey and 15 in follow-up interviews. 83% of surveyed passengers correctly identified all three COVID-19 associated symptoms listed in PHE information at that time. Most could identify the recommended actions and found the advice understandable and trustworthy. Interviews revealed that passengers shared concerns about the lack of wider official action, and that passengers’ knowledge had been acquired elsewhere as much from PHE. Respondents also noted their own agency in choosing to self-isolate, partially as a self-protective measure.ConclusionPHE COVID-19 public health information was perceived as clear and acceptable, but we found that passengers acquired knowledge from various sources and they saw the provision of information alone on arrival as an insufficient official response. Our study provides fresh insights into the importance of taking greater account of diverse information sources and of the need for public assurance in creating public health information materials to address global health threats.What is already known?In the containment phase, PHE issued public health advice at the major UK ports of entry to arriving travellers in response to the COVID-19 outbreak.What are the new findings?The majority of passengers correctly identified all three symptoms of COVID-19 highlighted in the PHE advice at the time and understood the importance of reporting symptoms and self-isolation.Knowledge about COVID-19 was also acquired elsewhere and was often more extensive than the information provided in official PHE guidance.PHE advice was perceived as clear and acceptable but insufficient on its own as an official response to the pandemic.What do the new findings imply?Our evaluation shows that while the PHE leaflets and posters met the intended aim of providing information and guidance, passengers used the provision of information and other visible public health measures to judge the adequacy of governmental response to the pandemic.Our study provides fresh insights into the need to take greater account of the diverse information sources from which international travellers may draw.Our study indicates that public health measures instituted at borders should be appraised not only with respect to their functional effectiveness in contributing to infection control, but also for their perceived effectiveness in furnishing public assurance of official action to contain the disease threat, which could be helpful in building public trust and thereby encouraging adherence to official guidelines.Our study demonstrates the complexity of health policy decision-making in public health emergencies of international importance and highlights the importance of establishing efficient mechanisms for rapid appraisal and feedback to public health and regulatory authorities of evidence that could contribute to containment and control of epidemic disease threats.