During the COVID-19 pandemic, self-isolation has been established as a vital approach for interrupting the spread of the virus, reducing community transmission and saving lives. For this strategy to be effective, individuals must be willing to self-isolate, feel adequately supported to do so and understand the detail of what they have been asked to do.
ScotCen was commissioned by the Scottish Government to conduct research with the aim of measuring rates of compliance with the requirement to self-isolate among those in the Test and Protect system in Scotland. In addition the research aimed to evaluate how well those asked to isolate understood the self-isolation guidance, and explore individual experiences of isolation, including barriers and facilitators to successful compliance.
A mixed method approach, comprising a survey followed by in-depth interviews with a sample of survey participants, was undertaken. The survey collected data, primarily online, from three key groups in the Test and Protect system:
1. Index Cases: Those asked to self-isolate after testing positive for COVID-19
2. Contact Cases: Those identified as having been in close contact with someone who tested positive
3. International Travellers: Those arriving into Scotland from outside the UK
Survey invitations to those eligible to take part were issued directly from Test and Protect via either SMS or email. A total of 4325 Test and Protect cases took part in the survey (Wave 1= 917 (7%), Wave 2=1748 (8%), Wave 3=1660 (9%)). In-depth interviews were carried out with 30 survey participants who consented to being recontacted for a follow-up interview.
Compliance with the requirement to self-isolate
Overall, compliance with self-isolation was high among survey participants of all case types (Index Cases, Contact Cases, International Travellers). Qualitative findings indicated that people complied with self-isolation requirements in order to protect the wider population by reducing the transmission of COVID-19. However, there was variance evident between how compliant people thought they had been when compared with an objective measure of compliance. This suggests that some participants may have lacked the knowledge, willingness and/or capability to self-isolate successfully.
Full compliance was higher amongst some participants than others:
Across all case types, compliance was higher among those who agreed that self-isolation is an effective strategy.
Among Contact Case participants, compliance was higher for those who lived with someone who tested positive than among those who had been in close contact with someone outside their household.
For Index and Contact Cases, compliance was higher for: women, those aged 65 and over, those who accepted the offer of Local Authority support and those aware that the isolation period should be 10 days.
Among International Travellers, compliance was higher for those in managed isolation than for those isolating at home. International Traveller participants in the youngest age group (aged 16-24) were significantly less likely than other participants to have fully adhered to the self-isolation requirements.
Although there was high compliance with all elements of self-isolation requirements across case types, compliance with specific elements varied by case type. Among Index and Contact Case participants, compliance with the requirement to remain at home during self-isolation and the requirement to avoid close contact with people from outside the household declined across the fieldwork period (small but statistically significant variations) while the requirement to isolate for 10 days declined for all case types over this period.
Instances of non-compliance with self-isolation requirements were low across all case types although this is likely, in part, due to the opt-in nature of the survey. Over half of Index and Contact Case participants did not do any of the non-compliant activities listed in the survey. However, there were instances of non-compliance with requirements either in the period between being advised to self-isolate and its commencement, or during the isolation period.
Non-compliant activities undertaken by participants before or during self-isolation included: visiting shops for groceries, toiletries or medicine; taking part in outdoor recreation or exercise; and attending work, school or university. Additional non-compliant activities mentioned by qualitative participants included: dog walking; driving members of their household to get a COVID-19 test or to go to work; and delivering groceries to a neighbour who was also self-isolating.
Knowledge of rules and guidance
Understanding of what was permitted during the self-isolation period was high among all case types though there was some ambiguity about whether leaving self-isolation for a medical reason, to care for a vulnerable person, or get/send a COVID-19 test was allowed.
The majority of survey participants of all case types knew that a 10 day self-isolation period was required after an individual tested positive for COVID-19. However, the proportion was much lower for International Travellers: 37% of International Traveller participants though the period was longer (14 days).
High proportions of all case types knew that the requirement for those in contact with someone who tested positive was 10 days even after a negative test result for the Contact Case.
For several activities there was a clear association between knowledge of whether an activity was allowed or not and whether a person carried out the activity themselves. However, knowledge of self-isolation requirements did not guarantee compliance. A number of qualitative interviewees knowingly breached self-isolation requirements. Those who admitted to doing so said these were minor infractions and they tried to minimise risks to others.
Attitudes & experiences of self-isolation
Agreement that self-isolation is an effective strategy against the spread of COVID-19 was high among all case types, though lower among International Traveller participants than Index and Contact Case participants. Support for the strategy strengthened with increased age.
There was some evidence of a relationship between endorsement of the strategy and compliance with the requirement (for all case types), with those who were fully compliant more likely to strongly agree than those who were partially compliant.
One fifth of International Traveller participants (particularly those in managed isolation) did not agree that international travel restrictions will help reduce the spread of COVID-19 and new variants of it.
Half of survey participants expressed that the experience of self-isolation had impacted negatively upon their mental health, with younger people, those in managed isolation and those experiencing repeated self-isolation particularly affected.
Isolation also impacted on peoples finances. Younger people, those with a household income of <=£16,900, and those living in the two most deprived SIMD quintiles in Scotland were likely to cite self-isolation impacting negatively upon their employment and income in all case types.
Index and Contact Case participants who tested positive on their most recent test were more likely to comply fully with self-isolation than those who tested negative (80% and 75% respectively).
Qualitative interviewees who undertook testing at home commented that the instructions for testing were clear and easy to understand.
Half of the Index and Contact Case participants had received at least one dose of vaccine, with 15% having received both doses at the time of completing the survey. Among qualitative interviewees, motivating factors for accepting a vaccine were to protect themselves and others and believing that the vaccines were effective in reducing the risk of catching and transmitting COVID.
No significant association between compliance with the self-isolation regulations and vaccination status were observed for any case type. A high level of intended future compliance with self-isolation regulations (82%), even once vaccinations had been given, was reported amongst Index and Contact Cases. However, only 61% of International Travellers said they would self-isolate if asked to do so once fully vaccinated, while 19% indicated they would not.
Support during self-isolation
A fairly high level of awareness of formal support existed among Index and Contact Case participants.
Over half (56%) indicated that they were offered the option of their Local Authority contacting them. Smaller proportions recalled being offered online support, the National Assistance Helpline number and/or support when visiting a test centre. Yet 29% did not recall being offered any of these formal support options.
Participants aged 25-44 and 45-64 were more likely than the youngest and oldest age groups to mention having received an offer of Local Authority contact, as were those living with others (adults and/or children), and those managing comfortably on their income during self-isolation.
In the qualitative research, interviewees were not always able to say if offers of support around self-isolation came from Test and Protect, the Local Authority or the NHS. Furthermore, while most interviewees were aware that Local Authorities offered support, they did not always know what the support entailed.
Uptake of Local Authority support was relatively low among Index and Contact Case survey participants, with 14% of those offered the opportunity of contact from their Local Authority accepting the offer.
The vast majority of Index and Contact Case participants that were offered the option of contact from their Local Authority declined the offer, with most doing so because they did not need any additional support.
The majority of Index and Contact Case survey participants responded that they had support from friends, family or neighbours outside of their household if they needed it, a higher proportion than among International Travellers. Those who had less access to informal support were more likely to take-up the formal support offer.
Uptake of the Self-Isolation Support Grant (SISG) was low. Only 8% of Index and Contact Case participants indicated that they had applied for a SISG, with no variation by case type.
Around a fifth of all Index and Contact Case participants did not apply because they did not know about the grant. This was higher among those on lower incomes.
Most Index and Contact Case participants who had contact with their Local Authority, indicated that their support needs had been met (84%).
Only small proportions of International Traveller participants directly sought assistance from either their Local Authority and/or via the National Assistance Helpline, with no significant variations by whether they were on a managed isolation package or self-isolating and testing at home.
Most International Travellers who sought formal support either from their Local Authority directly and/or via the National Assistance Helpline agreed that their support needs were met (72%).
In the qualitative interviews, all case types said they would have benefited from more support in the form of clear and easy to find information on self-isolation requirements and support available to them during isolation. Suggestions included: providing everyone who is isolating with a written list of sources of support and relevant contact details (available in a range of formats); improving the accessibility and clarity of guidance available on the relevant government and NHS websites (including for International Travellers); and offering resources to help people look after themselves physically and mentally during isolation.