Covid-19 Post-Shielding Research: October 2023

5. Guidance and Communications

This chapter focuses on the views of research participants in relation to guidance and communication, during the HRL period and subsequently.

5.1 Reflections on the Scottish Government guidance during the HRL

When asked to consider past Scottish Government guidance in relation to Covid-19, issued while the HRL was in operation, survey participants expressed varying degrees of agreement across four key dimensions: clarity, trustworthiness, reassurance, and impartiality, see Figure 5.1:

• 44% of both the total survey respondents and those who had been asked to shield strongly or somewhat agreed that the government's past guidance was impartial. In terms of disagreement, 22% of the total sample disagreed and 19% of those who had been asked to shield disagreed that it was impartial.
• The concept of reassurance found favour among 48% of the total sample of survey respondents while 26% disagreed. Around half (51%) of those who had been asked to shield agreed that this guidance was reassuring while 23% disagreed.
• Trustworthiness was considered positively by 50% of all survey respondents while 25% did not think it was trustworthy. There was a corresponding agreement rate of 53% among those who had been asked to shield and 23% disagreed.
• A majority (55%) of survey respondents agreed (somewhat agree or strongly agree) concerning the clarity of this guidance while 24% disagreed. Within the subgroup of those who had been asked to follow additional advice, a similar pattern emerged, with 53% indicating agreement and 22% disagreeing.

Base: n=3,317

The qualitative interviews revealed that many participants who had been asked to shield regarded the Scottish Government's Covid-19 guidance around shielding as comprehensive and appreciated the government's efforts to keep the public informed. A significant point of distinction from the UK Government was the regularity of updates provided by the Scottish Government, which reassured many participants.

Analysis of interviews showed participants who reported satisfaction with the amount and accuracy of Covid-19 guidance often had direct contact with healthcare professionals, such as consultants. This direct communication with healthcare providers complemented government and NHS-provided information. For these individuals, ongoing contact with their doctors, transplant consultants, or oncologists was considered invaluable. This contact, particularly during the peak of the pandemic, typically involved phone calls, and it allowed participants to address concerns and receive tailored advice.

In some cases, where participants had frequent contact with healthcare providers as a result of their condition, they were in a position to seek clarity directly from their provider on anything they were unsure of in the government’s guidance and to ask questions when they were unsure. Additionally, they advised that it was reassuring to hear the same advice from the government and their healthcare provider. In other cases, participants said that they often had to rely on word-of-mouth information and felt unsure about the guidelines, what they should or should not do, and where to access accurate information. Additionally, those without regular contact with their healthcare providers were less certain about the guidance as it applied specifically to them.

‘I think I did get letters eventually, but initially it was the consultant oncologist, who advised me to do that, and the cancer…I need tip a salute to the cancer care nurses – again who gave me the same advice and the GP and my surgical consultant. So, basically, we're all singing out the same hymn sheet - just keep away from people…absolutely clear. And they were all reinforcing it all the time. So again, hats off to them. It was very, very clear. And it was very, very clear that any risk taking was my decision.’

5.2 Reflections on the Scottish Government guidance after the end of the shielding list and since

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, see Figure 5.2:

• The perception of impartiality received 34% agreement from the total sample and 23% disagreement. Among those who had been asked to shield, 32% agreed, but 26% disagreed.
• Regarding reassurance, 36% of the total sample agreed, but 26% disagreed. Among those who had been asked to shield, 37% agreed, while 30% disagreed.
• Trustworthiness garnered 37% agreement among the total sample, with 27% in disagreement. Among those who had been asked to shield 37% agreed, while 28% disagreed.
• When it came to clarity, 38% of the total sample agreed, while 27% disagreed. Among those who had been asked to shield, 37% agreed, but 29% disagreed.

These results underscore the varying public opinions on the effectiveness of the Scottish Government's post-Highest Risk List guidance.

Base: n=3,317

The survey delved into public perceptions of the current Covid-19 guidance provided by the Scottish Government, exploring various aspects of understanding and trust painting a mixed picture (see figure 5.3):

• When it comes to reassurance of the guidance, the findings were comparable. 24% of the total sample strongly agreed or somewhat agreed that the guidance is reassuring, while 24% disagreed. In the shielding subgroup, 25% agreed with the guidance being reassuring, while 27% disagreed.
• Trustworthiness yielded a similar pattern, with 29% agreement and 23% disagreement. Among those who had been asked to shield trustworthiness received 28% agreed and 26% disagreed.
• The clarity of information from the Scottish Government on Covid-19 garnered a mixed response, with 29% of the total sample finding it clear while 31% disagreed. The shielding subgroup similarly exhibited a mixed perception, with 29% in agreement and 31% in disagreement.
• Understanding who to reach out to for guidance was another area of concern, with 30% of the general population reporting that they either strongly or somewhat agreed and 36% strongly or somewhat disagreed. Among those previously shielding, 34% agreed, but 33% disagreed, indicating a need for clearer communication channels in this regard.
• 43% of the total sample indicated that they know what the current guidance entails, with 16% strongly agreeing and 27% somewhat agreeing. However, a considerable 34% disagreed with this statement, comprising 15% who somewhat disagreed and 19% who strongly disagreed. Among those who had been shielding, a similar pattern emerged, with 42% agreeing and 29% disagreeing, signifying a varied level of comprehension within this group.
• In terms of finding the current guidance confusing, 24% of the total sample reported confusion, with 8% strongly agreeing and 15% somewhat agreeing. On the other hand, 23% disagreed, with 11% somewhat disagreeing and 12% strongly disagreeing. Among those who had been shielding, 27% found it confusing, while 23% disagreed.

Base: All n=3,317

One significant theme that emerged during interviews revolved around the changing rules and regulations, which made adaptation to living with Covid-19 more complicated. Reflecting on their experiences, many interviewees found it challenging to know which guidelines to follow, given the frequent alterations. The varying rules in different settings, such as shops, added an additional layer of complexity, requiring individuals to navigate distinct guidelines. These inconsistencies made it difficult to adapt and led to confusion. One participant reflected on this by saying:

‘And so at points, things were clear about what to do, but at points it was insane. And it became too choppy and changey, you know, with everything there's grey areas, with everything that you do in life there's things that don't fit neatly into one or another. So, I think it did maybe become a wee bit too convoluted…It feels kind of like one big mixed ball of a period of a few years where so many things were different and chopping and changing and you're back on furlough and you're back at work and then you're back on furlough and it's just, all very choppy changey’

Some participants recognised that the frequent changes in guidance during the pandemic about how people should behave and what was safe at different points could sometimes make the situation less clear. They described this period – when the country was emerging from the pandemic somewhat, and certain restrictions were lifted and then perhaps reinstated at a later date – as chaotic and confusing, characterised by the constant adjustments in rules and restrictions. Some mentioned that the evolving guidance left many grey areas, necessitating personal judgment to fill the gaps.

Many participants revealed that they had transitioned from following government guidelines meticulously to assessing risks themselves. They noted that they felt they had to use personal judgment and interpret guidance according to their specific circumstances. They believed that government guidance often contained ambiguities, which led them to make independent risk assessments based on the available information. This growing complexity prompted a shift in some people from strict adherence to government guidelines to a more nuanced approach based on individual risk assessments as restrictions were lifted.

Participants noted that seeking information had become a more active process once official restrictions had finished. They found themselves researching and accessing guidelines independently, representing a shift from the past when they received comprehensive guidance through official letters. This new emphasis on self-directed information retrieval marked a notable change. This lack of immediately available guidance also contributed to many interviewees no longer strictly following official government guidance but again opting to rely on their own personal risk assessments instead. The absence of comprehensive and readily available information from the government made it challenging for them to discern the situation and the appropriate actions, leaving them to rely on their own judgment.

‘I am [assessing the risk myself]…[Government information/assessment of risk] is just guidelines, it’s up to yourself to take out of it what you want and obey what you want, so it’s more or less what I’m taking out of it myself… I feel I’m still going above and beyond what’s actually in the guidelines right now’

Stakeholders stated that government guidance for those on the HRL was not always clear to their members, and often required explanation by staff members. Stakeholders themselves expressed difficulty understanding constantly changing guidance, often obscured across multiple websites, requiring staff to go from a ‘link to a link to a link’ to find information for those who had been asked to shield. Stakeholders called for more ‘joined up thinking’ between GPs, specialists and NHS staff in this process, recalling inconsistency in the quality and quantity of advice during and after the period where the list was in operation.

5.3 Guidance and advice

When it comes to making decisions about resuming activities post-restrictions and the highest risk list, the survey participants weighed various factors, see Figure 5.4.

Among all respondents, 24% relied on existing Scottish Government guidance, 15% considered advice from a clinician and 13% took into account the Scottish Government guidance from the period when the HRL was in operation,

In comparison, for those with had been asked to shield, 31% considered advice from a clinician, 23% relied on existing Scottish Government guidance, and 18% referred to Scottish Government guidance from the restriction period. Additionally, a smaller percentage specified other considerations (4% for all, 6% for those with shielding experience). Among other sources of guidance, those that selected ‘other’ generally specified that they consider UK Government advice and their own common sense/judgement.

A majority (57%) indicated that none of the listed factors influenced their decision-making. This figure was lower among those who had been asked to shield (42%).

Base: All n=3,317, ASE n=487

5.4 Reflections on Scottish Government’s Vaccination roll-out communications

Vaccines played a critical role during the pandemic in protecting those on the Highest Risk List and encouraging them to return to normal life. In fact, early eligibility for vaccines was cited as a key benefit to being on the highest risk list.

Yet, issues with vaccine rollout impacted quality of life for those that were at highest risk, during and after the Covid-19 pandemic. Stakeholders discussed various concerns expressed about vaccinations, including:

• Receiving near monthly vaccines at the start, with little explanation of the necessity,
• Long lag-time between receiving vaccines and the lessening of other restrictions,
• Issues in vaccine access, including timing and location of vaccines,
• Lack of coordination of delivery between GP surgeries, specialist, and vaccine providers.

Problems with vaccine rollout were seen as the responsibility of the Scottish Government and reflect general issues in communication – including a lack of communication and coordination - to those at the highest risk of Covid-19. One stakeholder shared:

‘If you look at it from a booster point of view, we’re still hearing issues around communication when it comes to the current booster, but also the spring booster as well. We had … patients that didn’t receive a letter at all, their spring booster letter was delayed. People were telling us that they had no contact from their vaccination team and the GP surgery couldn’t help them and their nurse specialist … could only forward on emails, things like that, so it’s still vital that people on the highest risk list or people that were on the highest risk list continue to receive clear and timely instruction from the Scottish Government’ [Stakeholder].

5.5 Awareness of Government Schemes

When it comes to awareness of certain schemes, such as the Distance Aware Scheme, the survey results reveal varying degrees of familiarity among the respondents. Of all participants, 7% claimed to know a lot about the Distance Aware Scheme, while 15% had heard of it and had some knowledge, while 9% were aware of it but had little information. The majority (62%) hadn't heard of it at all, and 7% were unsure.

Among the previously shielding subgroup a larger proportion, 15%, stated that they knew a lot about the Distance Aware Scheme, with 22% having heard of it and having some knowledge and 9% knew of it but had limited information. Conversely, 48% had never heard of the scheme, and 7% were unsure.

Regarding the COVID Sense Signage Pilot (later known as the Stay Well This Winter Signage Scheme until it was renamed the Stay Well Signage Scheme in March 2023), only 2% of all respondents claimed to know a lot about it, 7% had heard of it and had some knowledge and 6% were aware of it but didn't have any substantial information. However, a substantial 76% said that they had never heard of this scheme, while 8% indicated uncertainty.

Among those with experience of shielding a slightly larger 5% knew a lot about the scheme, 9% had heard of it and had some knowledge and 9% knew of it but had limited information. Nevertheless, a significant 68% had never heard of it, and 8% were uncertain.

The majority of interview participants expressed unfamiliarity with two government schemes, namely the Distance Aware Scheme and the Stay Well Signage Scheme.

One interview participant, who was an exception among the qualitative participants, mentioned knowing about the Distance Aware Scheme. However, they found it to be less effective because its success depended on the awareness of others:

‘Personally, I have the card and the lanyard... I used it initially when restrictions eased, and I went out. But honestly, I don't use it anymore. It seemed like not many people were aware of it. It wasn't well-publicised. I had the badge on my bag and the lanyard upfront so that people behind and in front of me could see it, but I don't think it made a significant difference. It's hard to gauge, as it relies on how others react to it.’

This participant indicated that their awareness of the scheme was likely due to their proactive information-seeking nature, suggesting that the scheme might not have been effectively communicated to the public.

In contrast, stakeholders, who were more familiar with these schemes, observed that the Distance Aware Scheme had successfully conveyed the concept of maintaining a safe distance. However, the COVID Sense Signage Scheme had lost some of its initial momentum and was less recognisable. Stakeholders believed the ‘Stay Well this Winter’ scheme to be less recognisable and impactful, as most people primarily associated "Stay Well this Winter" messaging with flu vaccines.

The level of awareness and the perceived effectiveness of these schemes varied among participants and stakeholders. While some individuals actively sought out information and engaged with these schemes, many remained unaware of their existence. This divergence highlights the need for more comprehensive and widely disseminated public awareness efforts.