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Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation

Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation
Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation
Background: The national shielding programme was introduced by UK Government at the beginning of the COVID-19 pandemic, with individuals identified as clinically extremely vulnerable (CEV) offered advice and support to stay at home and avoid all non-essential contact. This study aimed to explore the impact and responses of “shielding” on the health and wellbeing of CEV individuals in Southwest England during the first COVID-19 lockdown.

Methods: A two-stage mixed methods study, including a structured survey (7 August—23 October 2020) and semi-structured telephone interviews (26 August—30 September 2020) with a sample of individuals who had been identified as CEV and advised to “shield” by Bristol, North Somerset & South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG).

Results: The survey was completed by 203 people (57% female, 54% > 69 years, 94% White British, 64% retired) in Southwest England identified as CEV by BNSSG CCG. Thirteen survey respondents participated in follow-up interviews (53% female, 40% > 69 years, 100% White British, 61% retired). Receipt of ‘official’ communication from NHS England or General Practitioner (GP) was considered by participants as the legitimate start of shielding. 80% of survey responders felt they received all relevant advice needed to shield, yet interviewees criticised the timing of advice and often sought supplementary information. Shielding behaviours were nuanced, adapted to suit personal circumstances, and waned over time. Few interviewees received community support, although food boxes and informal social support were obtained by some. Worrying about COVID-19 was common for survey responders (90%). Since shielding had begun, physical and mental health reportedly worsened for 35% and 42% of survey responders respectively. 21% of survey responders scored ≥ 10 on the PHQ-9 questionnaire indicating possible depression and 15% scored ≥ 10 on the GAD-7 questionnaire indicating possible anxiety.

Conclusions: This research highlights the difficulties in providing generic messaging that is applicable and appropriate given the diversity of individuals identified as CEV and the importance of sharing tailored and timely advice to inform shielding decisions. Providing messages that reinforce self-determined action and assistance from support services could reduce the negative impact of shielding on mental health and feelings of social isolation.
COVID-19, Health policy, Infection control, Public health, Shielding
1471-2458
Lasseter, Gemma
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Compston, Polly
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Robin, Charlotte
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Lambert, Helen
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Hickman, Matthew
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Denford, Sarah
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Reynolds, Rosy
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Zhang, Juan
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Cai, Shengan
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Zhang, Tingting
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Smith, Louise E.
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Rubin, James
a1b1aed4-81d0-4a77-9731-988d6e242344
Yardley, Lucy
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Amlôt, Richard
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Oliver, Isabel
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Lasseter, Gemma
ed36b7c6-a473-48fb-b844-7e9fc52fa897
Compston, Polly
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Robin, Charlotte
dd478b8a-0dca-4edb-a549-bd60e771ee1b
Lambert, Helen
efd371f7-fb37-43b7-98e8-e9d012c6920d
Hickman, Matthew
8b795a4c-bff4-4e47-9694-0b7e12b3ed40
Denford, Sarah
8970b5a7-8cad-4356-ad0e-88297b67db37
Reynolds, Rosy
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Zhang, Juan
1839982d-6c65-45fd-990b-7b2b8f07a90c
Cai, Shengan
8ef64998-e81f-4735-8184-78b6af3a899e
Zhang, Tingting
dc40ceb4-ffc0-4457-a688-98177d239ba4
Smith, Louise E.
4cfb9721-9982-4c96-b170-db664248117b
Rubin, James
a1b1aed4-81d0-4a77-9731-988d6e242344
Yardley, Lucy
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Amlôt, Richard
d93f5263-ea24-4b12-b505-f51694220b8e
Oliver, Isabel
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Lasseter, Gemma, Compston, Polly, Robin, Charlotte, Lambert, Helen, Hickman, Matthew, Denford, Sarah, Reynolds, Rosy, Zhang, Juan, Cai, Shengan, Zhang, Tingting, Smith, Louise E., Rubin, James, Yardley, Lucy, Amlôt, Richard and Oliver, Isabel (2022) Exploring the impact of shielding advice on the wellbeing of individuals identified as clinically extremely vulnerable amid the COVID-19 pandemic: a mixed-methods evaluation. BMC Public Health, 22, [2145]. (doi:10.1186/s12889-022-14368-2).

Record type: Article

Abstract

Background: The national shielding programme was introduced by UK Government at the beginning of the COVID-19 pandemic, with individuals identified as clinically extremely vulnerable (CEV) offered advice and support to stay at home and avoid all non-essential contact. This study aimed to explore the impact and responses of “shielding” on the health and wellbeing of CEV individuals in Southwest England during the first COVID-19 lockdown.

Methods: A two-stage mixed methods study, including a structured survey (7 August—23 October 2020) and semi-structured telephone interviews (26 August—30 September 2020) with a sample of individuals who had been identified as CEV and advised to “shield” by Bristol, North Somerset & South Gloucestershire (BNSSG) Clinical Commissioning Group (CCG).

Results: The survey was completed by 203 people (57% female, 54% > 69 years, 94% White British, 64% retired) in Southwest England identified as CEV by BNSSG CCG. Thirteen survey respondents participated in follow-up interviews (53% female, 40% > 69 years, 100% White British, 61% retired). Receipt of ‘official’ communication from NHS England or General Practitioner (GP) was considered by participants as the legitimate start of shielding. 80% of survey responders felt they received all relevant advice needed to shield, yet interviewees criticised the timing of advice and often sought supplementary information. Shielding behaviours were nuanced, adapted to suit personal circumstances, and waned over time. Few interviewees received community support, although food boxes and informal social support were obtained by some. Worrying about COVID-19 was common for survey responders (90%). Since shielding had begun, physical and mental health reportedly worsened for 35% and 42% of survey responders respectively. 21% of survey responders scored ≥ 10 on the PHQ-9 questionnaire indicating possible depression and 15% scored ≥ 10 on the GAD-7 questionnaire indicating possible anxiety.

Conclusions: This research highlights the difficulties in providing generic messaging that is applicable and appropriate given the diversity of individuals identified as CEV and the importance of sharing tailored and timely advice to inform shielding decisions. Providing messages that reinforce self-determined action and assistance from support services could reduce the negative impact of shielding on mental health and feelings of social isolation.

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Accepted/In Press date: 17 October 2022
Published date: 22 November 2022
Keywords: COVID-19, Health policy, Infection control, Public health, Shielding

Identifiers

Local EPrints ID: 473334
URI: http://eprints.soton.ac.uk/id/eprint/473334
ISSN: 1471-2458
PURE UUID: d3ec9814-ee4c-40f3-8eae-d998e40f0881
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

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Date deposited: 16 Jan 2023 17:34
Last modified: 17 Mar 2024 02:47

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Contributors

Author: Gemma Lasseter
Author: Polly Compston
Author: Charlotte Robin
Author: Helen Lambert
Author: Matthew Hickman
Author: Sarah Denford
Author: Rosy Reynolds
Author: Juan Zhang
Author: Shengan Cai
Author: Tingting Zhang
Author: Louise E. Smith
Author: James Rubin
Author: Lucy Yardley ORCID iD
Author: Richard Amlôt
Author: Isabel Oliver

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