Barriers to and strategies to address COVID-19 testing hesitancy: a rapid scoping review

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Abstract

Background

Testing is a foundational component of any COVID-19 management strategy; however, emerging evidence suggests that barriers and hesitancy to COVID-19 testing may affect uptake or participation and often these are multiple and intersecting factors that may vary across population groups. To this end, Health Canada’s COVID-19 Testing and Screening Expert Advisory Panel commissioned this rapid review in January 2021 to explore the available evidence in this area. The aim of this rapid review was to identify barriers to COVID-19 testing and strategies used to mitigate these barriers.

Methods

Searches (completed January 8, 2021) were conducted in MEDLINE, Scopus, medRxiv/bioRxiv, Cochrane and online grey literature sources to identify publications that described barriers and strategies related to COVID-19 testing.

Results

From 1294 academic and 97 grey literature search results, 31 academic and 31 grey literature sources were included. Data were extracted from the relevant papers. The most cited barriers were cost of testing; low health literacy; low trust in the healthcare system; availability and accessibility of testing sites; and stigma and consequences of testing positive. Strategies to mitigate barriers to COVID-19 testing included: free testing; promoting awareness of importance to testing; presenting various testing options and types of testing centres (i.e., drive-thru, walk-up, home testing); providing transportation to testing centres; and offering support for self-isolation (e.g., salary support or housing).

Conclusion

Various barriers to COVID-19 testing and strategies for mitigating these barriers were identified. Further research to test the efficacy of these strategies is needed to better support testing for COVID-19 by addressing testing hesitancy as part of the broader COVID-19 public health response.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13127-7.

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Most cited references 48

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PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation

Adrian Aldcroft, Chantelle Garritty, Simon Lewin … (2018)

Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts, theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers, publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews.

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Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century

D Nutbeam (2000)

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Is Open Access

Barriers of Influenza Vaccination Intention and Behavior – A Systematic Review of Influenza Vaccine Hesitancy, 2005 – 2016

Philipp Schmid, Dorothee Rauber, Cornelia Betsch … (2017)

Background Influenza vaccine hesitancy is a significant threat to global efforts to reduce the burden of seasonal and pandemic influenza. Potential barriers of influenza vaccination need to be identified to inform interventions to raise awareness, influenza vaccine acceptance and uptake. Objective This review aims to (1) identify relevant studies and extract individual barriers of seasonal and pandemic influenza vaccination for risk groups and the general public; and (2) map knowledge gaps in understanding influenza vaccine hesitancy to derive directions for further research and inform interventions in this area. Methods Thirteen databases covering the areas of Medicine, Bioscience, Psychology, Sociology and Public Health were searched for peer-reviewed articles published between the years 2005 and 2016. Following the PRISMA approach, 470 articles were selected and analyzed for significant barriers to influenza vaccine uptake or intention. The barriers for different risk groups and flu types were clustered according to a conceptual framework based on the Theory of Planned Behavior and discussed using the 4C model of reasons for non-vaccination. Results Most studies were conducted in the American and European region. Health care personnel (HCP) and the general public were the most studied populations, while parental decisions for children at high risk were under-represented. This study also identifies understudied concepts. A lack of confidence, inconvenience, calculation and complacency were identified to different extents as barriers to influenza vaccine uptake in risk groups. Conclusion Many different psychological, contextual, sociodemographic and physical barriers that are specific to certain risk groups were identified. While most sociodemographic and physical variables may be significantly related to influenza vaccine hesitancy, they cannot be used to explain its emergence or intensity. Psychological determinants were meaningfully related to uptake and should therefore be measured in a valid and comparable way. A compendium of measurements for future use is suggested as supporting information.

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Author and article information

Contributors

Mark Embrett:

ORCID: http://orcid.org/0000-0002-3969-0219

membrett@dal.ca

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 14 April 2022

Publication date PMC-release: 14 April 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 750

Affiliations

[1 ]GRID grid.55602.34, ISNI 0000 0004 1936 8200, Faculty of Health, , Dalhousie University, ; Halifax, NS Canada

[2 ]GRID grid.458365.9, ISNI 0000 0004 4689 2163, Research, Innovation & Discovery, , Nova Scotia Health Authority, ; Halifax, NS Canada

[3 ]GRID grid.55602.34, ISNI 0000 0004 1936 8200, Healthy Populations Institute, , Dalhousie University, ; Halifax, NS Canada

[4 ]Maritime SPOR Support Unit, Halifax, NS Canada

[5 ]GRID grid.55602.34, ISNI 0000 0004 1936 8200, School of Nursing, , Dalhousie University, ; Halifax, NS Canada

[6 ]GRID grid.25073.33, ISNI 0000 0004 1936 8227, Department of Family Medicine, , McMaster University, ; Hamilton, ON Canada

[7 ]GRID grid.25073.33, ISNI 0000 0004 1936 8227, Department of Health Research Methods, Evidence and Impact, , McMaster University, ; Hamilton, ON Canada

[8 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Health Services Outcomes and Evaluation Unit, Faculty of Medicine, , Rehabilitation Sciences Institute, University of Toronto, ; Toronto, Canada

[9 ]GRID grid.55602.34, ISNI 0000 0004 1936 8200, School of Health and Human Performance, , Dalhousie University, ; Halifax, NS Canada

[10 ]GRID grid.414870.e, ISNI 0000 0001 0351 6983, IWK Health Centre, ; Halifax, NS Canada

[11 ]GRID grid.415502.7, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, ; Toronto, Canada

[12 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Epidemiology Division, Dalla Lana School of Public Health and Institute for Health, Management, and Evaluation, , University of Toronto, ; Toronto, Canada

Author information

Mark Embrett http://orcid.org/0000-0002-3969-0219

S. Meaghan Sim http://orcid.org/0000-0003-4477-3833

Hilary A. T. Caldwell http://orcid.org/0000-0003-2951-4542

Leah Boulos http://orcid.org/0000-0002-9849-383X

Ziwa Yu http://orcid.org/0000-0002-7694-5233

Gina Agarwal http://orcid.org/0000-0002-5691-4675

Rhiannon Cooper http://orcid.org/0000-0001-9076-5178

Allyson J. Gallant AJ http://orcid.org/0000-0002-2933-7470

Iwona A. Bielska http://orcid.org/0000-0002-4186-4871

Jawad Chishtie http://orcid.org/0000-0001-8650-4469

Janet Curran http://orcid.org/0000-0001-9977-0467

Andrea Tricco http://orcid.org/0000-0002-4114-8971

Article

Publisher ID: 13127

DOI: 10.1186/s12889-022-13127-7

PMC ID: 9008387

PubMed ID: 35422031

SO-VID: 86a43fbe-7338-426f-a62f-5e7424d5a687

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 28 September 2021

Date accepted : 28 March 2022

Custom metadata

ScienceOpen disciplines: Public health

Keywords: covid-19,testing,testing hesitancy,health policy,social determinants of health,equity,coronavirus,scoping review

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ScienceOpen disciplines: Public health

Keywords: covid-19, testing, testing hesitancy, health policy, social determinants of health, equity, coronavirus, scoping review

Barriers to and strategies to address COVID-19 testing hesitancy: a rapid scoping review

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Supplementary Information

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Novel Coronavirus Disease COVID-19

Most cited references 48

PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation

Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century

Barriers of Influenza Vaccination Intention and Behavior – A Systematic Review of Influenza Vaccine Hesitancy, 2005 – 2016

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