A longitudinal study of COVID-19 disclosure stigma and COVID-19 testing hesitancy in the United States

Abstract

Objectives

This study examines the relationship between COVID-19 disclosure stigma and COVID-19 testing hesitancy and assesses their changes between November 2020 and 2021.

Study design

Longitudinal cohort.

Methods

355 participants completed four study waves between November 2020 to November 2021. Factor analyses and Cronbach’s alpha assessed the factor structure and internal consistency of the COVID-19 Disclosure Stigma scale. Paired t-tests and McNemar’s Chi-squared test assessed change between study waves. Multivariable logistic regression models examined the relationship between COVID-19 disclosure stigma and testing hesitancy at 4 study waves.

Results

COVID-19 Disclosure Stigma declined significantly between the last study waves (p=0.030). The greatest disclosure concern was reporting a positive test to close contacts (Range: 19-21%) followed by disclosure to friends (Range: 10-15%) and family (Range: 4-10%). Over the course of the four study waves, COVID-19 testing hesitancy when symptomatic ranged from 23% to 30%. Older age, female gender, and having received a COVID-19 vaccine were associated with decreased odds of testing hesitancy. Greater COVID-19 Disclosure Stigma and more conservative political ideology showed a consistent relationship with increased odds of COVID-19 testing hesitancy.

Conclusions

Study findings suggest that many people anticipate feeling stigmatized when disclosing positive test results, especially to close contacts. A substantial percentage of study participants reported hesitancy to be tested when symptomatic. This study identifies a need for interventions that normalize COVID-19 testing (e.g., engaging leaders with conservative followings), provide strategies for disclosing positive results, and allow anonymous notification of potential COVID-19 exposure.