Facilitators to getting tested
For those motivated to get tested, key drivers were: a desire to protect the community; a belief that mass testing could help the city return to normality; and a belief that testing would be (or experience that testing was) convenient and efficient.
Protecting the community
Wanting to protect their community was a key motivator for those who engaged with the testing programme. This included a motivation to protect their loved ones, which in turn would have wider implications for public health.
There was also a wider understanding of community, beyond immediate family and friends. For example, people wanted to protect vulnerable people, both within their family and elsewhere. Within this, they fulfilled a sense of duty and felt by engaging with the asymptomatic testing they were contributing to saving lives.
Return to normality
Tied in with wanting to protect the community was the anticipation of being able to return to “normal”. There was an understanding that pulling together as a community would not only help protect others and save lives, but would also help the city recover quicker, specifically reducing the number of cases and entering a lower tier following the national lockdown.
Positive experience
Among commenters who did get tested, some discussed positive experiences of the testing process itself. These positive experiences were noted throughout the testing process, including ordering tests or booking test slots.
Positive experiences were also shared for the time spent at the test site, specifically how organised the process was. In addition, the kindness of the staff working at the test centres was noted as part of their positive experience of the end-to-end test experience.
Shared social identity with others in Liverpool and with authorities
There is a strong sense of social identity associated with the city of Liverpool; the city is who people are and where they belong. Where people identified with others in the city, as well as with authorities managing the response, shared identity operated not only as an individual motivator to get tested, but also to encourage others to do the same. There was a sense of wanting to come together as a community, not only to help the city but also the rest of the country. Rather than seeing this as a sacrifice on behalf of the rest of the country, it was seen as an opportunity to demonstrate that Liverpool can successfully manage the virus, setting an example for everyone else.
Rather than viewing being chosen as the city to pilot testing as negative, the feeling of social identity and an emotional connection with the city helped people understand the pilot as an opportunity and privilege for the city, for example being the first place out of lockdown or into a lower tier following the end of the national lockdown.
Barriers to getting tested
Analysis of the data highlighted several barriers to people getting tested. The key barriers identified were confusion about the overall pilot; practical barriers to testing; concern over the risk of transmission; and lack of trust in the mass testing programme, and in government response generally.
Practical barriers
A key practical barrier to getting tested was inconvenience associated with attending testing sites. Various factors associated with inconvenience were identified, including long queues at testing sites, and poor organisation of the testing process.
In addition, there was frustration that the booking system did not help to reduce queue length on attending the testing site – those who experienced long queues despite advanced booking were less motivated to try again. In some cases, people shared their negative experiences on social media, for example around queues, disorganisation or delays in getting results; this may have influenced others’ decisions in regards to getting a test.
Another practical barrier to getting tested related to concerns about the consequences of someone testing positive. For example, some individuals raised lack of compensation if required to self-isolate as the result of a positive test as a reason for not getting tested.
Risk of transmission
As well as long queues being a barrier to accessing testing because of the inconvenience, they also contributed to concerns over the risk of transmission. For some, the risk of catching Covid while queuing resulted in them not wanting to get tested. In some cases, commenters who had participated in testing reported lack of distancing at test sites, with symptomatic people having to queue alongside asymptomatic people.
Uncertainty around accessing testing
The uncertainty surrounding the pilot, particularly in the first few days of launch, led to questions being raised in local narratives. These were predominantly related to access to testing, how to book, where the test sites were, whether there were separate sites for asymptomatic testing and who would be conducting the tests. Uncertainty around how to access testing sometimes resulted in people attending the wrong test centres and having the wrong test, or being unable to book tests at all.
Uncertainty around the purpose of testing
There was also confusion surrounding the purpose of mass testing and how it would help the overall Covid response. In addition, there was the perception that there was no practical purpose for getting tested because there would be no individual benefit to knowing your disease status, particularly if asymptomatic. Other drivers for not getting tested were concern about the use of mass testing for surveillance or DNA gathering.
Lack of trust
In addition to the more passive barriers outlined above, there was a motivation to actively avoid participation in mass testing, sometimes expressed alongside a discouragement to others or criticism of fellow residents who had been or were planning to get tested. A key factor motivating people to not get tested was lack of trust. This included lack of trust in the accuracy of the test and lack of trust in stakeholders involved in the delivery of mass testing, such as national and local government, scientists and Test and Trace.
Those who displayed low trust in the mass testing process, and in government response generally, highlighted potential adverse consequences of mass testing for Liverpool. These potential consequences focused on two main concerns; coercion by the state during mass testing and further restrictions following mass testing due to the rise in the number of known cases. The latter concern was related to the aforementioned lack of trust in the accuracy of the test, with commentators predicting an anticipated high number of false positive cases (sometimes referred to as a "casedemic") that would lead to further restrictions in Liverpool only, including a prolonged lockdown.
Shared social identity with others in Liverpool, but not with authorities
Analysis highlighted how social identity can have a dual role in understanding responses to testing. For those who identified with authorities managing the response, as well as with others in the city, this operated as a facilitator to getting tested (as described above). However, for those who did not trust the government response, and for whom there was no shared identity with authorities, shared identity with others in the city contributed to motivations not to get tested. In this instance, people felt that mass testing was something being imposed on them, rather than something they could engage with as a community.
This led to a sense of marginalisation; local communities felt disconnected from those making the decisions, particularly central government. Feeling disenfranchised from local and central government resulted in discussions around ulterior motives, highlighting a breakdown in trust between the local community in Liverpool and those in power.
In addition, the role of social identity in local narratives around testing resulted in some members of the community not wanting to conform with what others were doing. For this group, people who were participating in testing were viewed negatively; they had lost their identity and become “other” and therefore outsiders in the local community, which resulted in criticism for “conforming”.
Social identity also played a part in concern over “outsiders” coming to the city to deliver the testing programme and highlighted a lack of trust in central government.