Table 4 Recommendations from the Southampton Saliva Testing Programme to ensure mass engagement in testing for COVID-19

1. Testing should be delivered through local organisations (e.g. local authorities, universities, schools, hospitals) to both increase trust in the testing programme but also to promote collective efficacy;

2. Communications about testing should be clear, consistent and appeal to individual’s sense of community and altruism to motivate people to take part in the programme;

3. Creative and fun educational activities should be used to improve knowledge and understanding of the virus, so increasing motivation to protect each other and sense of agency in managing consequences of the pandemic;

4. Participants and local organisers should be involved in designing their programme and should be engaged in providing continuous feedback on the testing experience to enable real-time programme modifications. Involvement might be in advisory meetings, or through contributions to focus groups and interviews, or engagement in education activities;

5. Local organisations involved in delivering testing should be enabled to connect with one another to share best practice and create a local testing culture. Meetings between local organisations should be a routine part of the of the programme and continue throughout;

6. Those testing positive should be supported financially, psychologically, with food and medication and provided with reassurance and advice about how to minimise the possibility of transmission of infection to others;

7. Testing should be made as convenient for participants as possible, many of the types of modifications described in Table 3 achieved this aim, and all communications need to be in multiple languages as well as appropriate for children and young people;

8. Thought needs to be given to making testing kits and processes environmentally sustainable by reducing the number of plastic bags and tubes and recycling materials wherever possible.