Vaccine-hesitant individuals accumulate additional COVID-19 risk due to divergent perception and behaviors related to SARS-CoV-2 testing: a population-based, cross-sectional study

Abstract

Purpose: To investigate the perception of SARS-CoV-2 detection methods, information sources, and opinions on appropriate behavior after receiving negative or positive test results.

Methods: In a questionnaire-based, cross-sectional study conducted between September 1 and November 17, 2021, epidemiological, behavioral, and COVID-19-related data were acquired from the public in Munich, Germany.

Results: Most of the 1388 participants obtained information from online media (82.8%) as well as state and federal authorities (80.3%). 93.4% believed in the accuracy of SARS-CoV-2 PCR testing and 41.2% in the accuracy of rapid antigen tests (RATs). However, RATs were preferred for testing (59.1%) over PCR (51.1%). 24.0% of all individuals were willing to ignore hygiene measures and 76.9% were less afraid of SARS-CoV-2 transmission after receiving a negative PCR test (5.9% and 48.8% in case of a negative RAT). 28.8% reported not to self-isolate after receiving a positive RAT. Multivariate analyses revealed that non-vaccinated individuals relied less on information from governmental authorities (p = 0.0004) and more on social media (p = 0.0216), disbelieved in the accuracy of the PCR test (p ≤ 0.0001) while displaying strong preference towards using RATs (p ≤ 0.0001), were more willing to abandon pandemic-related hygiene measures (p ≤ 0.0001), less afraid of transmitting SARS-CoV-2 after a negative RAT (p ≤ 0.0001), and less likely to isolate after a positive RAT (p ≤ 0.0001).

Conclusion: Insights into preferred information sources as well as perception, preferences, and behavior related to SARS-CoV-2 testing and hygiene measures are key to refining public health information and surveillance campaigns. Non-vaccinated individuals' divergent believes and behaviors possibly increase their COVID-19 risk.

Keywords: COVID-19; PCR test; Rapid antigen test; SARS-CoV-2; Surveillance; Vaccination.

Fig. 1

Overview of the study population. A Demographic information on the study participants. Information is shown as percentage of all 1388 participants. B Age demographic of study participants by gender (blue and orange shaded) compared to Munich’s population in 2021 (gray shaded) [19]. C Percentage of COVID-19-vaccinated individuals among all participants (left) and percentages of non-vaccinated individuals willing to vaccinate (right). D Agreement and disagreement (partial or full) to different reasons for reluctance towards vaccination among those 97 participants indicating to be not or maybe willing to get vaccinated. Absolute numbers of participants giving certain answers are displayed

Fig. 2

Information sources for SARS-CoV-2 testing. A Agreement and disagreement (partial or full) on preferring different information sources for SARS-CoV-2 testing among all 1388 participants. Absolute numbers of participants giving certain answers are displayed. B, C Percentages of all participants agreeing (partially or fully) on gathering information on testing using different sources by age group (B) and vaccination status (C). Error bars indicate 95% confidence intervals. Asterisks next to brackets indicate statistical significance between groups calculated using Fisher’s exact test (C) or Fisher’s exact test with Holm’s testing correction (B). Asterisks below “mva” indicate statistical significance in multivariate analysis. If no asterisks are given, no statistical significance was detected. mva—multivariate analysis

Fig. 3

Belief in accuracy and personal preferences comparing different SARS-CoV-2 detection methods. A Agreement and disagreement (partial and full) on believing in the accuracy of the PCR and RAT and the statement of being unaware of differences between the two SARS-CoV-2 detection methods among all 1388 participants. B Percentages of all participants agreeing (partially or fully) on believing in the accuracy of the two testing methods or considering them indifferent by vaccination status. C Comparison of the estimated sensitivities of both testing methods among all participants. D Estimated sensitivities by participants’ highest degree of education. E Agreement and disagreement (partial and full) for preferring the PCR and RAT for COVID-19 testing among all participants. F–H Percentages of all participants agreeing (partially or fully) on preferring either of the two testing methods by healthcare worker status (F), vaccination status (G), and age group (H). Absolute numbers of participants giving certain answers are displayed in (A, E). Error bars in (B, F–H) indicate 95% confidence intervals. Box plots in (C, D) depict medians, bounds between upper and lower quartiles, and whiskers between the 10th and 90th percentiles. Asterisks above brackets indicate statistical significance between groups calculated with Fisher’s exact test (B, F, G), Wilcoxon rank sum test with continuity correction (C, D), and Fisher’s exact test with Holm’s testing correction (H). Asterisks next to “mva” indicate statistical significance in multivariate analysis. If no asterisks are given, no statistical significance was detected. compl.—completed, deg.—degree, dipl.—diploma, HCW—healthcare worker, mva—multivariate analysis, non-vacc—non-vaccinated, vacc—vaccinated

Fig. 4

Behavior after receiving a SARS-CoV-2 test result. A Agreement and disagreement (partial and full) on being willing to ignore hygiene measures shortly after receiving a negative PCR or RAT result and the statement that it is always necessary to adhere to COVID-19 specific hygiene measures regardless of testing among all 1388 participants. B, C Percentages of all participants agreeing (partially or fully) to being willing to ignore hygiene measures after receiving a negative test result or to adhere to hygiene measures, stratified by vaccination status (B) and age group (C). D Agreement and disagreement (partial and full) for being less afraid of SARS-CoV-2 transmission after receiving a negative PCR or RAT result specifically and, in general, since the beginning of the vaccination campaign. E, F Percentages of all participants agreeing (partially or fully) to being less afraid after receiving a negative test result or, in general, since the beginning of the vaccination campaign by vaccination status (E), and age group (F). G Participants’ responses on what they believe is the appropriate behavior after receiving a positive RAT. Data is shown as percentages of all 1388 participants. H Percentages of all participants agreeing that quarantining is the appropriate behavior after receiving a positive RAT by vaccination status. Absolute numbers of participants giving certain answers are displayed in (A, D). Error bars in (B, C, E, F, H) indicate 95% confidence intervals. Asterisks above brackets indicate statistical significance between groups calculated with Fisher’s exact test (B, E, H), and Fisher’s exact test with Holm’s testing correction (C, F). Asterisks next to “mva” indicate statistical significance in multivariate analysis. If no asterisks are given, no statistical significance was detected. h—hours, hyg.—hygiene, mva—multivariate analysis, neg.—negative, non-vacc—non-vaccinated, pos.—positive, vacc—vaccinated