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Review
. 2023 Aug 4;13(8):e073464.
doi: 10.1136/bmjopen-2023-073464.

Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study

Alison Porter  1 , Ashley Akbari  2 , Andrew Carson-Stevens  3 , Jeremy Dale  4 , Lucy Dixon  5 , Adrian Edwards  3 , Bridie Evans  2 , Lesley Griffiths  5 , Ann John  2 , Stephen Jolles  3 , Mark Rhys Kingston  2 , Ronan Lyons  2 , Jennifer Morgan  6 , Bernadette Sewell  7 , Anthony Whiffen  8 , Victoria Angharad Williams  2 , Helen Snooks  2
Affiliations
Review

Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study

Alison Porter et al. BMJ Open. .

Abstract

Introduction: Shielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the first year of the pandemic from March 2020. As the first stage in the EVITE Immunity evaluation (Effects of shielding for vulnerable people during COVID-19 pandemic on health outcomes, costs and immunity, including those with cancer:quasi-experimental evaluation), we generated a logic model to describe the programme theory underlying the shielding intervention.

Design and participants: We reviewed published documentation on shielding to develop an initial draft of the logic model. We then discussed this draft during interviews with 13 key stakeholders involved in putting shielding into effect in Wales and England. Interviews were recorded, transcribed and analysed thematically to inform a final draft of the logic model.

Results: The shielding intervention was a complex one, introduced at pace by multiple agencies working together. We identified three core components: agreement on clinical criteria; development of the list of people appropriate for shielding; and communication of shielding advice. In addition, there was a support programme, available as required to shielding people, including food parcels, financial support and social support. The predicted mechanism of change was that people would isolate themselves and so avoid infection, with the primary intended outcome being reduction in mortality in the shielding group. Unintended impacts included negative impact on mental and physical health and well-being. Details of the intervention varied slightly across the home nations of the UK and were subject to minor revisions during the time the intervention was in place.

Conclusions: Shielding was a largely untested strategy, aiming to mitigate risk by placing a responsibility on individuals to protect themselves. The model of its rationale, components and outcomes (intended and unintended) will inform evaluation of the impact of shielding and help us to understand its effect and limitations.

Keywords: COVID-19; protocols & guidelines; public health; qualitative research.

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Conflict of interest statement

Competing interests: RL, SJ, AJ and AE are members of the Welsh Government COVID-19 Technical Advisory Group (TAG). AJ is also cochair of the Scientific Pandemic Insights Group on Behaviours (SPI-B) which is a subgroup of the Scientific Advisory Group for Emergencies (SAGE) advising the UK government. SJ is also a member of the Welsh Government Testing TAG and Cardiff University COVID Strategic Advisory Board (SAB).

Figures

Figure 1
Figure 1
Logic model describing the shielding intervention. NHS, National Health Service; PR, public relations.
See this image and copyright information in PMC

References

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