Why “one size fits all” is not enough when designing COVID-19 immunity certificates for domestic use: a UK wide cross-sectional online survey

Objectives

The present study explored public’s willingness to use COVID-19 immunity certificates across six different domestic scenarios.

Design

Cross-sectional online survey.

Setting

UK representative survey conducted on the 3^rdof August 2021.

Participants

534 UK residents over 18 years old.

Interventions

Participants replied to the same set of questions.

Primary and secondary outcome measures

The primary outcome measure waswillingness to useimmunity certificates across three different domestic settings (1. Visiting the GP for a non-urgent health issue, 2. Dining in a restaurant, and 3. Attending a performance in a theatre). For each setting two options, one prioritisingconvenience(option A) and the otherprivacy(option B), were offered. Our secondary outcome measures were computed indices from items adapted from the Health Belief Model; Attitudes towards sharing immunity status with service providers; Prior to COVID-19 lifestyle. In addition, we recorded data about respondents’ socio-demographic characteristics.

Results

Respondents were more willing to use immunity certificates that prioritisedconvenience, rather thanprivacy, when visiting their GP (92%). However, privacy was more favorable (84%) in the other two settings (dining in a restaurant and going to a theatre) compared toconvenience(39%). Personal beliefs about COVID-19 and immunity certificates were associated with variations in willingness to use these across all scenarios. No variations were observed across socio-demographics and lifestyle.

Conclusions

The findings of this survey suggest that there is notone size fits allsolution for designing immunity certificates. Immunity certificates are complex socio-technical systems, any attempt to implement these for domestic use should be tailored to different settings and user needs. The design of certification services requires a more evidence-based approach and further research is needed to understand how different settings, design elements (likeconvenienceorprivacy) and personal beliefs about the pandemic should inform their design.

Strengths and limitations of this study

• This study presents unique knowledge about the public’s willingness to use immunity certificates for domestic purposes where there is very little published research at the moment.

• The study reports knowledge about the interaction between individual characteristics, domestic settings, and types of immunity certificate design on willingness to use these certificates.

• UK nationally representative sample for age, gender, and ethnic background, but limited to people who have the means and capacity to use digital technologies (survey administered using Prolific.co).

• We present evidence-based recommendations for Public Health services and policy makers about the use of immunity certificates in different domestic settings.

• Since, as to the writing of this paper, COVID-19 certification has not been mandated in the UK, the scenarios used in the survey were hypothetical.