21 April, 2024

 

A word from our Director: The HPRU is proud to support the MSc module on Disaster Response: Mental Health, Communication and Behaviour, as part of the MSc Mental Health Studies at King’s College London. Each year, students on the module are given the chance to write blogs about papers produced by the Unit. We are delighted to present this recent submission by Fangxuan Du that is based on a paper that we co-produced with the HPRU in Behavioural Science and Evaluation:

Lasseter, G., Compston, P., Robin, C., Lambert, H., Hickman, M., Denford, S., Reynolds, R., Zhang, J., Cai, S., Zhang, T., Smith, L. E., Rubin, G. J., Yardley, L., Amlôt, R., & Oliver, I. (2022). 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. BMC Public Health, 22(1).

 

Did Shielding Advice Help Clinically Extremely Vulnerable People during the COVID-19 Pandemic?

Background

Imagine you and many people are sailing separately in a river, each with the possibility of sinking, and suddenly you are told that your boat is fragile and more likely to sink, how would you feel?

Early in the COVID-19 pandemic, up to 1.3 million people were identified as clinically extremely vulnerable (CEV). Due to pre-existing conditions, they suffered an unequal impact of the pandemic. In the UK, people who were CEV were advised by the government to ‘shield’, including staying at home for 12 weeks, and even isolating themselves from family members.

While shielding advice aims to protect, can it cause harm? Analogous interventions during the 2003 SARS epidemic were found to have detrimental effects on the mental health of quarantined individuals. However, shielding, as a long-term and widespread intervention, has had little investigation into its possible impact.

Based on the voices of CEV individuals, Lasseter and colleagues were at the forefront of exploring the effectiveness and acceptability of shielding advice and its impacts on wellbeing during the COVID-19 pandemic.

Methods

This was a two-stage mixed-methods study in which the authors explored the responses and wellbeing of CEV individuals advised to shield in Southwest England. First, 203 participants completed a survey, focusing on demographic characteristics, advice-related questions, and wellbeing self-assessment. Then,13 participants took part in follow-up telephone interviews to answer questions about their experiences related to receiving shielding advice during the first UK lockdown.

Results

Acceptability of shielding advice

• Timing dilemmas

Most survey responders felt they received all the shielding advice they needed and followed it from the beginning. However, interviewees reported receiving official shielding advice at different times. Two interviewees even reported never receiving official advice after being identified as CEV.

• The need for further information

Most interviewees found that information from the daily Government televised briefings was not relevant to CEV individuals and chose to supplement shielding advice from multiple sources. Some interviewees indicated that these daily briefings triggered feelings of being forgotten and ignored.

Attitudes and behaviours

• Difficulties in fully following advice

Most survey responders shielded on a household basis, which was considered to be the only realistic approach. No interviewees were able to fully follow the Government's shielding advice, which was replaced by adapted and personalised shielding behaviours that weakened over time.

• The importance of community support

The survey showed that the levels and types of support received by participants varied and, consistent with the interviews, came mainly from friends and family. All interviewees agreed that community support that could help to maintain shielding behaviours was essential for following shielding advice.

Impact of shielding

• Timely healthcare interactions

  Most survey responders with healthcare needs successfully accessed the services, and interviewees said that even if they encountered difficulties initially, they were quickly resolved.

• Worries about physical health

Survey responders reported that shielding had made their physical health worse. Although most interviewees had private gardens or outdoor spaces that served as their key resource of leisure and exercise, they were still troubled by the lack of freedom and insufficient exercise.

• Decline in self-reported mental health

Nearly all survey responders were worried about the coronavirus. Up to one in five survey responders reported clinical levels of depression, anxiety or PTSD symptoms.

Conclusions

Overall, the findings show that CEV individuals experienced different difficulties and suffered physically and mentally when receiving public health messages and adopting shielding advice. This study highlights the importance of connecting with the public during shielding implementation as well. The researchers further suggest the community can be a vehicle for operating support mechanisms that can be beneficial to CEV individuals in similar future contexts.

Strengths and limitations

This study filled the research gap in this field by sharply focusing on CEV individuals during the pandemic and providing insights into shielding limitations and its improvement measures. However, the research question highlighted in the title, "the impact of shielding advice on wellbeing", could be answered more completely by screening for factors influencing the subjective wellbeing of CEV individuals.

Implications for practice

Prior health education on general infection risk for CEV individuals should be enhanced to help them develop appropriate risk perceptions for future responses. A previous study showed that higher prior general infection risk perception may have led to a lower incidence of COVID-19. There is a need to improve the official shielding list and shielding policies for CEV individuals. Due to the heterogeneity of CEV individuals, it is important to grade them according to different realistic levels of risks among individuals with CEV and adjust the risk grading according to their condition or drug use. This requires bridging communication between multiple professionals such as public health workers, advice developers and healthcare providers to synchronise information which can ensure that consistent, accurate and timely information is disseminated to CEV individuals.

About the author: Fangxuan Du is an MSc Mental Health Studies student at King's College London. Her research interests include bullying, first responders’ mental health, and cognitive behavioural therapy.