Covid-19 Post-Shielding Research: October 2023

Executive Summary

Research Context

The Scottish Government commissioned independent researchers, Diffley Partnership, to conduct a mixed method study on Covid-19 Post Shielding. The study had three aims as follows:

1. Explore how those previously on Scotland’s Shielding List, later known as the Highest Risk List (HRL) are adapting to living with Covid post-lockdown measures in terms of their behaviour and how they continue to protect themselves as well as their views towards the current approach to managing Covid,

2. Measure the scale and nature of any ongoing shielding behaviours, and whether those are necessary or may be preventing a return to a better quality of life unnecessarily,

3. Explore the views of those previously on the HRL on the support, communications and guidance available to them.

Approach

Qualitative and quantitative research was conducted in the following order:

• Firstly, an online survey was conducted between 26 – 31 July 2023 and received 3,316 responses. This was used to identify those who had been asked to shield [547] and analysis was carried out on this sub-sample.
• Secondly, interviews with members of the public. Utilising the survey as a recruitment method, a sample of members of the public who had previously been on the HRL was established. One-to-one interviews were conducted with 15 of these individuals.
• Thirdly, a stakeholder roundtable. This online session was held on September 11, 2023. This included representatives of four organisations who represent groups of the Scottish public who were on the HRL.

These three research methods culminated in analysis and findings summarised below.

Experience of Shielding

The qualitative interviews and stakeholder discussions explored participants' experiences of shielding during the Highest Risk List (HRL) period of March 2020 to May 2022.

Some found shielding more manageable due to living arrangements and practical support, while others faced challenges. Practical support varied, with some receiving home deliveries and assistance, and others reporting that they did not receive any practical support, and relied on relatives and neighbours for support. Clear guidance was crucial, as it affected work arrangements, and delays in issuing guidelines caused additional stress where people relied on these to have adjustments made for them.

Psychological challenges were common, with fear of Covid-19 overwhelming some. People's behaviour varied, driven by an informed fear of the virus or a realistic assessment of vulnerability.

Being on the HRL brought reassurance to some, as it recognised their vulnerability and communicated their level of risk. However, initial confusion about shielding restrictions and limited outdoor activity raised concerns.

In summary, shielding experiences were shaped by various factors, including living conditions, practical support, and clear guidance. While being on the HRL provided comfort to some, challenges related to support and isolation also emerged.

Attitudes and Behaviours Post Highest Risk List

The report explores the post-Highest Risk List (HRL) behaviours and attitudes of individuals in Scotland.

A distinction is evident between the general public and those who were asked to shield. When considering the total sample, 72% felt comfortable resuming most activities. Amongst those with shielding experience, a far lower proportion (49%) felt comfortable resuming most activities. How decisions are made was influenced by factors such as ventilation, the number of people present, and familiarity with them.

Common concerns following the ending of the list included people becoming complacent (43%) and others being less mindful of those who were on the HRL (37%). Encouragement for ongoing vaccination and better ventilation were perceived as top interventions to alleviate concerns.

The adaptation to living with Covid-19 varies, with some finding it easy and others struggling. Some people continue to engage in various shielding behaviours, often driven by habit and complex reasons. The need for clear, definitive guidance is emphasised, along with the importance of more data and information to enable informed decision-making.

There were also varying levels of anxiety about living with Covid-19, with some accepting it as part of life while others remained anxious due to safety concerns.

Guidance and Communications

Survey participants expressed varying degrees of agreement with past Scottish Government guidance concerning Covid-19 when the 'highest risk group' was identified. Notably, 55% of the general population agreed with the guidance's clarity, and trustworthiness garnered a 50% positive response.

Qualitative interviews revealed that many participants who had been on the HRL appreciated the comprehensive nature of the Covid-19 guidance provided by the government. They particularly commended the regular updates. However, changes in guidance, at times led to confusion. Those with direct contact with healthcare professionals found this invaluable, while others had to rely on word-of-mouth information, leading to confusion.

When considering guidance issued since the end of the Highest Risk List, survey participants expressed varying degrees of agreement across four key dimensions: clarity, trustworthiness, reassurance, and impartiality.

Public perceptions of the current Covid-19 guidance provided by the Scottish Government varied. While some felt they knew what the current guidance entailed, others found it confusing and were unsure about who to reach out to for guidance. The clarity of information from the Scottish Government on Covid-19 garnered mixed responses across both the total sample and those who had been asked to shield.

Making decisions about resuming activities post-restrictions and the highest risk list for those who had been asked to shield involved considering various factors, including advice from clinicians and government guidance. A majority indicated that none of the listed factors influenced their decision-making indicating that people were making decisions based on their own assessment of their risk.

Regarding awareness of government schemes, (including the Distance Aware Scheme and the Stay Well Signage Scheme) survey results revealed varying degrees of familiarity with many not being familiar with these initiatives across the total sample and those who had been asked to shield.

Overall, these findings reflect the complex and evolving nature of public perception, understanding, and experiences related to Covid-19 guidance and government initiatives in Scotland, emphasising the need for clear, consistent, and accessible communication to enhance public trust and understanding.

Looking to the future

Respondents who had been on the HRL expressed diverse views regarding their outlook on the future. Approximately 46% anticipated that they will no longer consider themselves in a separate higher-risk group. About 34% expected to remain worried for some time but believed this won't significantly affect their quality of life, while 20% expected ongoing worry that could impact their quality of life.

When considering the acceptability of future measures in response to another variant or Covid-19 surge, the majority of respondents found public health messaging, provision in shops such as ‘hand sanitiser stations’ or the use of face coverings in public settings, where these are not normally worn and physical distancing measures to be acceptable. There was less support for social distancing measures and less acceptance of physical restrictions and closures.

Concerning compliance with future measures, more than half of the respondents believed the entire population of Scotland should comply, while 19% thought only those vulnerable to Covid-19 should comply, and 10% believed no one should need to comply. A smaller percentage felt measures should target those not vaccinated against Covid-19.

Among those with shielding experience, there was a split in awareness regarding the Scottish Government's ability to recontact individuals on the Highest Risk List in the future, with 52% unaware of this option.

Participants' reflections on Covid-19 management in the future highlighted the need for improved identification of those who need to shield and clearer guidance. They stressed the importance of precise information from the government on the severity of Covid-19, and the potential long-term impact of Long Covid. Participants in the qualitative research wanted more detailed and updated information on new strains, vaccinations, and the rapidly changing situation. In the event of a substantial surge, they acknowledged the need for stricter measures and increased vigilance but also recognised the challenges of enforcing compliance.