The purpose of this work was to rapidly assess public attitudes to attending hospital across the UK for research purposes and clinical appointments. The findings showed patterns of response that may support efforts to recommence clinical and research activity in secondary care. Of particular note are findings around differences between the perceptions and attitudes of women and BAME respondents, which suggest a need to consider how current changes in activity might disproportionately impact some groups in society.
There is very little previous research into the risk perceptions associated with COVID-19, though our findings do reflect the paradoxical finding (10) that men are more at risk than women (11), but women perceive greater risk than men. This is consistent with a large body of research showing women perceive greater risk than men across a range of activities (12), but of particular interest as men are at greater risk of COVID-19. However, the lack of gender differences in respect of factors affecting feelings of safety would suggest the effect is underpinned by a requirement to see safety measures implemented i.e. the effect is a mix of the cognitive and emotive.
The differences between ethnic groups, with lower scores from our BAME respondents for both feelings of safety and intention to participate in research and/or attend clinical appointments, are particularly relevant. The disproportionate risk of contracting COVID-19 (13) and poorer outcomes in BAME groups compared to White counterparts (14) is a recognised public health issue. Public Health England has engaged with key stakeholders to start the process of understanding this health inequality and discuss strategies to reduce the direct and indirect impact of this pandemic and indeed any future pandemic. The results presented here add to the growing evidence for the need to work with local communities to reduce fear and rebuild the BAME communities trust in the health services. Strategies must be sought to increase attendance for routine appointments and to increase accessibility for the BAME communities. Further, as new recruitment efforts for COVID-19 research commences, a focus on working with the BAME communities is required to permit adequate ethnic representation in health research, because insufficient diversity in recruitment has consistently underpinned and exacerbated health inequalities. The lower feelings of comfort with new ways of working also highlights a potential area for further exacerbation of health inequality in service provision indicating services need to be patient-centred and offer choice of mode of contact.
The high perception of risk in attending Accident and Emergency (A&E), is notable and in line with recent findings (5). These results mirror what has been observed nationally with dramatic reduction in attendance to A&E and emergency admissions, April saw a staggering 57% drop compared to the same month in 2019 (7). The question is whether this is a positive change in public behavior or has this added to the indirect impact of COVID-19 on health. In both scenarios, work is required with the public and health systems to either continue diverting ‘treatment seeking’ away from A&E where it is not necessary or to break down this new fear of seeking emergency care.
Histograms for scales (not shown) showed there was a distinct grouping of respondents into those who felt safe and those who did not, with generally few people in the middle. This was partially accounted for by differences associated with sex and ethnicity, though interestingly there was no effect of age-related risk. Other factors may be associated with the bipolarity of responses, such as worldview, political inclination and sense of individualism, as identified in other recent research (10).
The factors affecting feelings of safety provide information on what participants expect to see when attending hospital. The highest rating for consistent use of PPE reinforces the recent decision to enforce use of PPE in hospitals by both visitors and staff in all areas. Findings suggest hospital attendees, particularly those at risk because of age/comorbidity, will also need to see strict cleaning procedures and social distancing. BAME respondents additionally rated off-site research visits and staff antibody and swab testing as important to their feelings of safety. In order to ensure representative recruitment to research and particularly rapid research around COVID-19, it will be important to consider how needs differ for potential BAME research participants in order to avoid perpetuating health inequalities.
Women and those at risk due to comorbidity were less likely to participate in research, suggesting potential participants consider personal relevance of the research and societal urgency when deciding if they will participate. This highlights a specific recruitment challenge when considering vaccine trials for COVID-19 that will need to recruit people with comorbidities. Escalation of vaccine research will require large-scale, public-facing recruitment that has not been attempted previously in the UK.
The respondents’ overall attitudes to research indicate a strong continued support for participation, interest and investment in health science research, though ambivalence about prioritising COVID-19 suggests this is partially generic. The pandemic, and increased health science coverage in the media, provides an opportunity to increase engagement across the board, with age-related disparities suggesting there is a need to engage younger/working age populations. Respondents again balanced risk with personal and social necessity, finding it most acceptable to be asked to attend a hospital for COVID-19 research and least so for healthy volunteer studies, with a near-significant lower acceptability for those with comorbidity.
Communication professionals should consider pre-recruitment engagement and messaging in order to 1) prime a new audience for recruitment into vaccine studies that have typically relied on staff and student recruitment and 2) prime under-represented audiences with good quality information on risk and risk management to support recruitment efforts.
Finally, respondents reported high levels of comfort with digital and remote ways of working which is reassuring for clinicians and researchers. However, it is important to consider the needs of the aging and BAME communities given the reported differences in preferences.
A limitation of this work is the much smaller number of BAME respondents (6%) compared to White (91%); resultant from the need to be responsive, this survey was undertaken rapidly, in just 2 weeks and only in English. Due to the limited nature of the sample, therefore, it is important to be cautious about generalising, especially as we found significant differences by ethnicity.