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. 2025 Apr 19;15(4):e089062.
doi: 10.1136/bmjopen-2024-089062.

Influence of context on engagement with COVID-19 testing: a scoping review of barriers and facilitators to testing for healthcare workers, care homes and schools in the UK

Billie Andersen-Waine #  1 , Claire Marriott Keene #  2 , Sophie Dickinson  3 , Reshania Naidoo  3   2 , Angus Ferguson-Lewis  3 , Anastasia Polner  3 , Ma'ayan Amswych  3 , Lisa White  4 , Sassy Molyneux  2   5 , Marta Wanat  6 ; EY-Oxford Health Analytics Consortium
Collaborators, Affiliations

Influence of context on engagement with COVID-19 testing: a scoping review of barriers and facilitators to testing for healthcare workers, care homes and schools in the UK

Billie Andersen-Waine et al. BMJ Open. .

Abstract

Objective: The UK government's response to the COVID-19 pandemic included a 'test, trace and isolate' strategy. Testing services for healthcare workers, care homes and schools accounted for the greatest spend and volume of tests. We reviewed relevant literature to identify common and unique barriers and facilitators to engaging with each of these testing services.

Design: Scoping review.

Search strategy: PubMed, Scopus and the WHO COVID-19 Research Database were searched for evidence published between 1 January 2020 and 7 November 2022. This was supplemented by evidence identified via free-text searches on Google Scholar and provided by the UK Health Security Agency (UKHSA).

Data extraction and synthesis: Data were extracted by a team of reviewers and synthesised thematically under the broad headings of perceptions, experiences, barriers and facilitators to engaging with the COVID-19 testing programme.

Results: This study included 40 sources, including 17 from projects that informed UKHSA's decisions during the pandemic. Eight themes emerged and were used to categorise barriers and facilitators to engaging with the testing services for healthcare workers, care homes and schools: (1) perceived value, (2) trust in the tests and public bodies, (3) importance of infrastructure, (4) impact of media and social networks, (5) physical burden of the test, (6) perceived capability to undertake testing, (7) importance of relevant information and 8) consequences of testing.

Conclusions: Universal barriers and facilitators to engagement with the testing programme related to the core elements of each testing service, such as uncomfortable specimen collection and the influence of media and peers; these could be mitigated or leveraged to increase engagement across settings. However, the individuals involved, perceptions of value and available resources differed across services, leading to unique experiences between settings. Thus, consideration of context is crucial when designing and implementing a testing programme in response to a pandemic.

Keywords: Behavior; COVID-19; Health Services.

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Conflict of interest statement

Competing interests: All authors had financial support from the UK Health Security Agency (UKHSA) for the submitted work; EY LLP London has previously received payment for consultancy and advisory work on the NHS Test & Trace response from the UK Department of Health and Social Care, now known as the UK Health Security Agency. There are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews flow diagram. UKHSA, United Kingdom Health Security Agency.
See this image and copyright information in PMC

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