Challenges to self-isolation among contacts of cases of COVID-19: a national telephone survey in Wales

Objectives

To identify the specific challenges of self-isolation experienced by population sub-groups to better target and tailor support.

Design

The C ontact A dherence B ehavioural In sights S tudy (CABINS) was a 15-minute telephone survey of confirmed contacts of cases of COVID-19 identified through the national NHS Wales Test Trace Protect (TTP) database.

Methods

Confirmed contacts of cases of COVID-19 reached by TTP completed a 15-minute telephone survey (N = 2,027). Binary logistic regression models adjusted for age, gender, living alone, survey round, deprivation quintile (defined by the Welsh Index of Multiple Deprivation) and income precarity (financial security) determined which population sub-groups were more likely to experience challenges during self-isolation.

Results

Younger people (aged 18-29 years) were 3 times more likely to report mental health concerns (Adjusted Odds Ratio [aOR]: 3.16, 95% Confidence Interval [CI]: 2.05-4.86) and 2 times more likely to report loneliness (aOR: 1.96, CI: 1.37-2.81) compared to people aged over 60 years. Women were 1.5 times more likely to experience mental health concerns (aOR: 1.51, 95% CI: 1.20-1.92) compared to men. People with high/very high levels of income precarity were 8 times more likely to report financial challenges (aOR: 7.73, CI: 5.10-11.74) and 3 times more likely to report mental health concerns than their more financially secure counterparts (aOR: 3.08, CI: 2.22-4.28).

Conclusions

Self-isolation is particularly challenging for those with younger people, women and precarious incomes. Providing enhanced emotional, financial and social support and signposting to these groups is required to minimise the harms of self-isolation.

What is already known on this subject?

• Self-isolation after notification as a contact of a positive case of COVID-19 is essential to prevent the spread of the disease. However, self-isolation can be challenging and adherence is dependent upon a range of psychological, social and economic factors.

• Emerging data suggests that the COVID-19 pandemic is having disproportionate impact on those on lower incomes and those of lower socio-economic status.

What does this study add?

• The most common challenges faced to self-isolation were wanting to see family and friends, followed by a lack of exercise.

• Individuals with some income precarity were more than 7 times more likely to report financial concerns and 3 times more likely to report mental health concerns as a challenge to self-isolation than those who were financially secure.

• Interventions to support individuals to self-isolate needs to be targeted at groups most susceptible to experiencing challenges to self-isolation for infectious diseases. Our research suggests that the use of income precarity questions as a screening tool is important to direct financial and practical support through contact tracing systems.