This descriptive study aimed to examine the characteristics and motivations of individuals accessing community LFD testing across two LAAs in the South West of England. We found most individuals who engaged with testing were female, between the ages of 20 and 59 (working age adults), white, and worked as early years or education staff, health and social care staff, and supermarket or food production staff. Most individuals got tested for work-related reasons, as well as having been in contact with infected individuals, feeling unwell or symptomatic, or to stop the spread of the virus. Individuals first heard about LFD testing through various channels including work, media, and word of mouth, and decided to get tested based on the ease and convenience of testing, workplace communications, and to identify asymptomatic cases to help stop the spread.
Increased female engagement with LFD testing across LAAs was likely due to the gender disparity in some of the ‘essential worker’ occupation categories with known limited access to testing at work. According to 2020 ONS data [17], women make up 83% of ‘care workers and home carers’, and 98% of ‘nursery workers and childminders’ in the UK. While the proportions of ethnic minorities among individuals accessing community LFD testing were similar to those of the LAA populations’ 2011 census ethnic distribution, more recent data from 2016 [18] show an increase in ethnic minority residents (by 1.5% in LAA1, and by 0.3% in LAA2). Therefore, our data suggest an underrepresentation of ethnic minorities accessing testing for these LAAs. While the greatest proportion of tests was taken by individuals living in LSOAs among the least deprived national IMD decile for both LAAs, tests were proportionally distributed relative to how many of each LAA’s LSOAs are in each national decile. Deciles with higher proportions of tests reflect a larger number of LAA LSOAs that fell into that IMD decile. For example, 31% of LAA1’s LSOAs (n = 51) were in the least deprived (10th) national decile, where 31% of all LAA1 tests were conducted. Our occupation data suggest communications targeting essential workers to get tested were successful, as individuals in these roles represented large proportions of our sample. However, our survey results indicated that our occupation response categories were lacking, as several occupations were identified that we had been unable to capture such as police, construction workers, and cleaners. There were also communication challenges during the study period. Changes due to shifts in national and local policy and strategies resulted in inconsistent messaging with regards to priority groups for, and frequency of, community testing. For example, in LAA1, some communications shared with community groups at the start of the testing offer presented confusing information. One presentation initially stated “anyone can access these tests” but went on to specify that “we are asking those who cannot work from home and who deliver key services to the community specifically to use this opportunity” to get tested. Communications to another community group suggested the prioritisation of testing “with critical workers and volunteers in roles which bring them into contact with the community being prioritised with the offer of weekly slots” but also stated that local residents were encouraged to take up the testing offer and stressed the importance of asymptomatic testing. An LAA1 internal staff news item from January 27th 2021—February 2nd 2021 provided clearer messaging, stating they were “targeting those who can't work from home in the current lockdown and those in areas with higher rates of Covid” for testing, and a further news item “Do I need to get Covid tested?” that ran from February 10th-15th that stated “The Lateral Flow Test is intended to be completed regularly by those living in areas with high infection rates and critical workers in the community”. However, when LAA1 opened their third testing site on February 22nd 2021, internal communications stated testing was recommended for “staff who cannot work from home and who come into contact with colleagues and the public in order to do their jobs” and made no mention of getting tested based on infection rates in local communities. Promotion of LFD testing was also problematic when surge testing programmes were deployed in LAA1. Due to concerns that the different types of tests could potentially confuse residents, surge testing messaging was prioritised by the LAA1 communications team during those periods.
Our findings regarding who is accessing testing are similar to those from a recent study reporting findings on social and spatial inequalities in uptake and case-detection of a community LFD testing pilot in Liverpool for asymptomatic residents that ran between 6th November 2020 to 31st January 2021 [18]. The authors also reported higher uptake among women and lower uptake among ethnic minority groups. However, while they found lower uptake and more positive tests among those living in the most deprived areas, we did not. However, we were unable to investigate this with the same spatial sensitivity and precision, instead relying on exploring number of tests by postcode data self-reported during test registration. Similar to our findings, a rapid scoping review that thematically analysed the findings of 47 studies to investigate motivations and barriers to seeking, accessing, and undertaking testing found that perceived convenience of testing site and endorsement from employers, educational institutions, peers, and/or colleagues encouraged the uptake of testing [19]. They also found that the perceived benefits of testing included to protect family, colleagues, and others in the community by reducing the spread of COVID-19, information about their disease status, and to contribute to scientific research and public management of the pandemic. In a recent study, researchers conducted interviews and focus groups with 223 staff, students, pupils and household members from schools, a university, and a community healthcare NHS trust to explore the experiences of individuals who took part in a weekly COVID-19 pilot testing programme [20]. Like our study, they found that communication, a sense of community, and convenience were crucial to people’s engagement with the testing programme, with participants feeling reassured by and proud of their participation in the programme to help manage the pandemic.
There were some limitations of our study. Total sample sizes differed by outcome as some individuals were tested without booking an appointment, some data for individuals who lived outside the LAAs were unavailable, and there was a delay in receiving test line data relative to booking platform data. We were only able to survey residents of LAA1, and despite many residents completing the survey, the survey’s low response rate is a limitation that should be considered when interpreting its findings. Additionally, our survey was not designed using any specific theoretical model, which could be considered for future studies (e.g., health belief model). Finally, due to the evolving and serious nature of the pandemic, services such as community testing have been introduced and initiated at pace. Consequently, evaluation has not always been built in from the outset, rendering it difficult to comprehensively assess the potential impact of these services and their ability to reach the most deprived and at-risk individuals within our populations. Future services should develop robust evaluation plans prior to launching, and ensure monitoring occurs throughout service delivery so that the service can change and adapt at pace when necessary to meet the needs of its target population. Additionally, while the Innova LFD tests used in this study were shown to have high sensitivity and specificity [16], their sensitivity drops for individuals with lower viral loads. Given the absolute number of false positives will be high when community prevalence of SARS-CoV-2 is low, their use should be continually evaluated, particularly for mass testing [4].
