Public health measure 2: Isolation	Study features	Outcomes and findings	Translational steps
Systematic reviews, guidelines
WHO 2021# Citation type: GL Actions for consideration in the care and protection of vulnerable populations from COVID‐19; interim guidance 13th October 2021; At: WPR-DSE-2020-021-eng.pdf (who.int) Public health measure: Isolation, and also maps onto quarantine, crowd avoidance, and general PD Mapping to: Uptake, acceptability, adherence, feasibility Mapping to: Theme 2: recipients of public communication: audience, setting and equity Theme 3: support for individual and population behavioural changes Theme 4: community engagement to support communication Theme 5: public trust and perceptions	Overview and aim: To provide guidance on care and protection of vulnerable populations during COVID‐19 Type of study and data: GL; rapid literature search and guideline development process Method: GL was developed based on a review of relevant literature/guidance on vulnerable populations. Recommendations decided through group consensus Included disease(s): COVID‐19 Timing: Revised October 2021; no further information specific to timing Countries included: Across‐country; developed by WHO Regional Office for the Western Pacific Intervention or phenomenon of interest: To strengthen the care & protection of vulnerable groups from community transmission during COVID‐19 Population addressed in GL: vulnerable populations defined as those experiencing any condition resulting in inequitable access to resources and increased likelihood of adverse health outcomes of COVID‐19. This includes (but not limited to): people living in overcrowded housing, collective sites, informal settlements or slums, or experiencing homelessness; people who have been forcibly displaced, migrant workers; those in rural and remote locations; people living in poverty; people with disability and those living in closed facilities; those adversely affected by the digital divide; and people affected by intersecting, accumulating or other vulnerabilities. Quality assessment: AGREE II: scope and purpose 86.1%; stakeholder involvement 25%; rigour of development 18.8%; clarity of presentation 77.78%; applicability 8.33%; editorial independence 50% Funding source: Not reported	Reported on: Guidance for the general population may not be feasible for vulnerable groups. Guidance here presents options for ensuring that recommended measures are accessible and appropriate for vulnerable populations; this can not only ensure more equitable access but also that COVID‐19 is controlled in vulnerable populations (which affects the health of the whole population). Findings summarised below focus on communication issues related to physical distancing barriers and mitigation of these for vulnerable groups. Some population groups may have less agency to comply with PD recommendations. Potential barriers impacting PD adherence/uptake include: People lacking clear, accurate and culturally appropriate information on how to protect themselves and others from the virus; People who lack formal housing; or live in dormitories, intergenerational housing or detention centres/prisons may have inadequate space to physically distance or may not be free to self‐isolate; Financial barriers: The need to keep working to maintain income. This may also include migrant workers who may not access testing or care because of their precarious legal or employment status; Being unable to survive alone in isolation and requiring carers to provide meals, care etc. Potential strategies for mitigating barriers include: Tailored community public information and/or engagement campaign targeting those most severely affected by COVID‐19; aim to provide clear, accurate, culturally appropriate information about how to observe physical distancing or care for sick people at home. Such messages need to be tailored for context and content (e.g. to those living in rural/remote locations) and/or for delivery (e.g. sign language for people with disabilities) to ensure reach to different vulnerable groups within the community. Engage with the community to identify and prepare alternative self‐isolation facilities for those with mild symptoms. Support this with technical guidance for local authorities and community health workers. Ensure appropriate monitoring processes are in place so that people with disabilities who may not be able to voice their concerns during isolation are protected from harm. Longer‐term mitigation strategies might include advocating for provision/expansion of paid sick leave; promoting intersectoral action to deploy and expand safety nets (e.g. cash transfers) to provide temporary relief to affected households; advocating for adequate housing; and advocating to prevent charges or fees for breaking quarantine where people are leaving dangerous households, or for those without adequate housing. Other relevant public communication activities are focused on the following: Ensure all vulnerable populations are informed of, and can access, healthcare for COVID‐19 treatment and have access to testing in appropriate languages. Provide access to support services, including mental health supports and disseminate information on coping strategies; these must be culturally appropriate and tailored to need. Train service providers appropriately to prevent and address stigmatisation/discrimination of vulnerable populations. Work to provide adequate social protection e.g. financial support in various forms appropriate to need, including those with precarious employment e.g. migrant workers. Promote factual national reporting to combat misinformation, stereotypes and stigmatisation by disseminating contextualised evidence‐based information to the public e.g. targeting fear/hostility for new or returning migrant workers. Communicate using digital technologies with awareness of the digital divide, and that disparities in digital literacy and accessibility exist and may exacerbate health inequalities. Supplementary communications may be needed to overcome this as a barrier e.g. providing opportunities for women and girls to learn and access digital services; communicate using non‐Internet systems (also in recognition of limited Internet penetration in some areas) to communicate e.g. SMS. Encourage the reduction of movement within & between areas by providing communities with alternative mechanisms to engage with family (e.g. phone credit and SIM cards). For people with disabilities: Ensure information is easy to read, at suitable literacy and comprehension levels for people with intellectual disability or cognitive impairments, and that these can be adapted for people with neurocognitive impairment (including those who cannot self‐report symptoms). Alternative communication strategies (e.g. sign language), and communication through multiple channels (e.g. radio, websites, television) is needed to ensure that people with disabilities receive adequate public health information to protect their health, and to be able to communicate with health professionals to raise concerns or questions. Including simultaneous interpretation into the locally relevant sign language, and transcripts, during major announcements may help to ensure accessibility of public health information. Build capacity amongst healthcare and other community workers to communicate with people with disabilities, in order that people adequately understand the required prevention/containment measures. Ensure people with disabilities have access to essential services (e.g. telehealth, food); and to care pathways that are easy to access and clearly communicate to people with disabilities, their carers and service providers. Ensure formal and informal caregivers for people with disabilities are considered part of the essential workforce and exempted from curfews and other restrictions that may affect their delivery of support or care. If carers are quarantined, continued care for people with disabilities needs to be assured. Facilitating people with disabilities and their carers to make contingency plans for such situations may be beneficial to ensure continuity of care. Ensure that there are no additional barriers to seeking care or support (e.g. social assistance) for people with disabilities e.g. physical inaccessible application points. Community engagement Build trust and engage in two‐way dialogue with community leaders/representatives/organisations with the capacity to facilitate the COVID‐19 response. Work with community partners to reach and empower vulnerable groups and address stigma undermining prevention measures. Engage with community representatives to understand community concerns/barriers/needs and identify localised solutions. Ask them to deliver key health messages, that can address concerns of specific groups, and capture community feedback to inform national decision‐making. Engage the community (through local leaders and government officials) to develop and disseminate local, culturally appropriate guidance on COVID‐19 preparedness, at locations that are frequented by vulnerable populations, which is checked for accuracy and relevance, and translated to local languages. Build capacity locally (community representatives, leaders) to disseminate information, address concerns and promote dialogue on specific needs of groups, such as those with lower literacy, visual, intellectual or other impairments. Information should include COVID‐19 prevention (protection) measures and when to seek care. Recommendations: Prevention and containment measures for the general population need to be adapted and supported in different ways for people with different vulnerabilities. This can include a range of communication, information, training and practical supports to help to mitigate the risk of COVID‐19 or of severe disease and to help to ensure more equitable health outcomes across the population.	Communication purpose: May be useful for identifying barriers and mitigation strategies for vulnerable communities in terms of prevention and containment of COVID‐19. Also provides guidance on communication strategies and features that may usefully inform tailoring of public health communications to differentially vulnerable groups within populations. Related to review questions: Identifies several factors which may create vulnerability in different groups and so increase their risk of poor outcomes related to COVID‐19. Provides a range of strategies, both material (practical) and communication‐related, that may be used with the aim of redressing the imbalances or inequalities faced by many vulnerable populations. Implementation of such strategies may help to reduce barriers to uptake of preventive measures and so improve accessibility, feasibility and adherence to physical distancing measures.
Cardwell 2021#^ Citation type: SR (rapid) Public health measure: Isolation, and also maps onto quarantine, and school measures Mapping to: Adherence Mapping to: Theme 3: support for individual and population behavioural changes	Overview and aim: To identify strategies to support people in isolation or quarantine for COVID‐19 and to assess effectiveness of strategies during respiratory pathogen pandemics to support and improve adherence to these measures Type of study and data: SR; international guidance documents (WHO, ECDC from 19 countries); rapid review of primary studies (n = 1, survey) Inclusion and exclusion criteria: Included: support for people in isolation or quarantine, respiratory viruses e.g. SARS, MERS Excluded: non‐respiratory pathogens or non‐pandemic settings Participant features and numbers, sampling details: General populations across 19 countries; no specific groups noted, although some countries may target support to vulnerable groups or those already receiving state aid. Two primary studies (same dataset): 1) 257 families, 49% under 12 years, 54% male; 2) 133 households Included disease(s): Respiratory diseases e.g. SARS, MERS, influenza Timing: Search up to January 2021, literature limited to 2000 onwards. No further information related to timing of the pandemic or related communications Countries included: International guidance from Austria, Australia, Belgium, Canada, Denmark, England, Finland, France, Iceland, Ireland, Netherlands, New Zealand, Northern Ireland, Norway, Scotland, Singapore, Sweden, Switzerland, Wales Rapid literature review: Australia All high‐income countries Intervention or phenomenon of interest: Support (any public health guidance or measures) for isolation or quarantine measures Quality assessment: 5/11 AMSTAR: [2. Single screening and data extraction only (second reviewer checked extracted data); 5. No excluded studies reported and included not very clear; 6. Characteristics of included studies not clearly reported; 8. Quality not incorporated into findings/conclusions; 10. Publication bias not assessed; 11. No COI included studies reported] Funding source: This research was funded in part by the Health Research Board under grant no. HRB‐CICER‐2016‐1871.	Reported on: Support measures from 19 countries were analysed and identified 5 categories of support. Psychological, addiction and safety support measures: Most countries (18/19) provided psychological supports including mental health, addiction and domestic violence supports, or various types including information leaflets/portals, access to helplines and online/video appointments with counsellors or psychologists. Information on fees to be paid for using services, or which services existed pre‐pandemic, was typically not reported. Authors also note that support services may exist even where government or agency websites do not list these as specific pandemic‐related support measures. Essential needs support measures: Individuals isolating or in quarantine should have access to essentials including food, medicines, accommodation, care (including healthcare and childcare), and PPE. Most countries (16/19) provided information on support related to people’s essential needs, but this ranged from comprehensive to more selective coverage. Information: All countries provided specific information support for those isolating or quarantining, and many also provided more comprehensive information related to COVID‐19 and a wide range of related issues. Most commonly information support was available via helplines or websites, and in some countries (n = 4), via mobile phone apps. Financial support: Financial support measures were reported by all countries. Some provided a certificate of requirement to isolate/quarantine in order to access financial supports. Payments were typically a fixed amount rather than a proportion of salary. One study reported different measures put in place to support people during isolation/quarantine for H1N1 in Australia, with positive cases in classrooms the trigger for school closures and quarantine. Provision of information on quarantine was linked to adherence with restrictive measures. Most people (90%) understood what they were meant to do during quarantine, with almost 90% of parents receiving quarantine information from the school, 63% from the health department and 44% from the media. Most families (76%) reported using two or more information sources, and most (around 67%) reported that information from the health department, schools or health services was useful or extremely so, while only 38% rated media‐sourced information at this level. Adherence to quarantine requirements was reported to be 55% overall and was higher amongst households who reported understanding what they were meant to do or not do during quarantine (55% versus 35%). Recommendations: Across countries there is variation in the type and intensity of support offered to people undertaking isolation or quarantine measures to protect public health during the COVID‐19 pandemic. Some countries target support to vulnerable groups; and many countries leverage support during the pandemic from existing services rather than creating new structures and services to provide such support. Most services are reactive, requiring individuals to initiate the support, although some proactively target vulnerable (medically or financially) populations. As well as support for isolation and quarantine, many countries have in place punitive measures for lack of adherence. Adherence to measures may be influenced by the culture in which the measures are implemented. Adherence to isolation and quarantine measures may be improved by better knowledge of the measures and their rationale, and provision of financial support and essential supplies. Providing consistent and factual information may promote adherence to measures; warning people about misinformation and addressing inaccuracies or conspiracies in available information is similarly important. Information and messages emphasising the supports that will be provided should isolation or quarantine be needed are beneficial, so that people know what is available as well as how to access supports, should they be needed. Framing messages positively in terms of the benefits for society and for themselves and communicating to promote solidarity and the altruistic nature of adherence, may also improve adherence.	Communication purpose: May inform the purpose(s) and range of supports available for people undertaking isolation or quarantine. May also inform communication strategies to inform individuals and communities about the supports available to them, including what these are, who is eligible, and how to access them, should they be needed.   Related to review questions: Different supports are needed for people undertaking isolation/quarantine. These range from information and mental health services to access to essential supplies, PPE and financial support. Supports may vary in intensity (comprehensiveness) and target (generally or to specific vulnerable populations). Clear, consistent information about isolation and quarantine measures, and their rationale and features (e.g. duration, what is required), is needed to help people know what to do and how to adhere to the measures. Information is also needed about what supports for isolation and quarantine are available, and how, where and who can access these supports, so that people are clear about the options in place and what to do if the situation requires it. Information may be consumed via multiple sources and communicated via different media, such as websites and helplines, information pamphlets and portals, and mobile phone apps. Financial insecurity is a major contributor to lack of adherence, particularly for those of lower socioeconomic status. Lack of suitable accommodation and essential supplies are further barriers, as are inconsistent information, stress and stigma associated with quarantine.
Chu 2020#^ Citation type: SR Public health measure: Isolation, and also maps onto quarantine Mapping to: Acceptability, adherence Mapping to: Theme 1: features of public communication: content, timing and duration, and delivery Theme 3: support for individual and population behavioural changes Theme 4: community engagement to support communication Theme 5: public trust and perceptions Theme 6: distancing measures in schools and workplaces	Overview and aim: To identify social consequences of mass quarantine (measures that restrict physical contacts and mobility of 10,000 or more people or all residents in a specific jurisdiction) during infectious disease outbreaks; and to identify strategies to mitigate negative social impacts of movement restrictions for COVID‐19 Type of study and data: SR; qualitative, quantitative and mixed methods studies; N = 15 (6 qualitative, 6 quantitative, 1 mixed‐methods, 2 ethical) Surveys (telephone, web‐based, mail; cross‐sectional), interviews and focus group methods and evidence synthesis (for ethical studies). Inclusion and exclusion criteria: Included: Social impacts of mass quarantine during infectious disease outbreaks; empirical research Excluded: Studies without peer‐reviewed original empirical evidence (e.g. thesis, book chapters and reviews) or focusing only on epidemiological consequences of mass quarantine (e.g. estimates of infection, disease rates/risks) Participant features and numbers, sampling details: Sample sizes ranged from small numbers of key informants (e.g. n = 9 to 42) to larger samples up to approximately 1000 people responding to surveys. Participants included residents of affected villages, regions, or cities, community leaders and key informants for organisations and communities, healthcare workers, printing company workers and university faculty. Included disease(s): SARS (8 studies), EVD (4), COVID‐19 (2), H1N1/influenza (1) Timing: Searches inception to April 9, 2020 Eight studies focused on 2003 SARS outbreak; 4 on 2014‐16 EVD outbreak; 1 on 2009‐2010 H1N1 outbreak; 2 on 2020 COVID‐19 outbreak. Quarantine range: 7 days to 1 month; not specified in 3 studies, not applicable in a further 2 studies Countries included: SARS outbreak Canada, China, across‐countries (8 studies): EVD Sierra Leone and Liberia (4), COVID‐19 China and multiple countries (2), H1N1/influenza Canada (1) Country income tended towards high and upper‐middle income (SARS, H1N1, COVID‐19); and low income for EVD. Intervention or phenomenon of interest: Social consequences of mass quarantine, and strategies to mitigate negative effects Quality assessment: AMSTAR 7/11: [5. No excluded studies list provided; 8. Quality assessment not integrated into most findings; 10. Publication bias not assessed; 11. No COI for included studies] Funding source: WT/Wellcome Trust/United Kingdom	Reported on: 6/15 studies were rated as low quality, 9/15 as high quality; with seven consequences of mass quarantine identified. Psychological distress (11 studies): Studies across diseases and countries reported that psychological impacts during/after mass quarantine include emotional distress and symptoms of mental illness, such as anxiety, life dissatisfaction, fear of infection, loneliness and mistrust. Mental health outcomes may be poorer amongst those who are unemployed. Other single studies reported that a substantial proportion of people under movement restrictions and physical distancing measures report insomnia, post‐traumatic stress disorder symptoms, and depression; and others indicate heightened mistrust between racial and religious groups (in terms of disease spread) and avoidance behaviours relating to people returning from regions of infection. Mass quarantine also led to stigma and could prevent people affected from accessing food or other essential items. Heightened communication inequalities (9 studies): Mass quarantine exaggerated inequalities in people’s access to, understanding of, and actions for preventing infection. One study in Canada reported that racial and linguistic minorities may have higher likelihood of inaccurate information on confinement measures as a result of lower literacy or lack of message clarity. Another highlighted distrust of the government amongst Liberian slum dwellers, due to a lack of information about military‐enforced lockdown targeting their homes and indicated that such enforced lockdown measures without community engagement may exacerbate distrust of authorities and decrease willingness to adhere to restrictions. One other study stressed the importance of government transparency of decisions on mass movement restrictions and public information about how outbreak surveillance works in order to avoid panic. Identifying trustworthy information was reported as challenging for the public as a result of diverse, unverified information sources; heightened uncertainty during outbreaks; lack of clear, consistent messaging from authorities (about why, how, and how long to enact quarantine); and inability to contact public health staff (3 studies). One study also reported that contradictory instructions about quarantine (from public health experts, mass media, experts) widened communication inequalities, increased the difficulty of adhering to measures, and led people to rely on word‐of‐mouth information that may not have been accurate. Being older (> 65 years), female and a healthcare worker were associated positively with knowledge and acceptance of mass quarantine (2 studies). People in poverty may not have space available for physical distancing in their households (1 study), a pattern noted in another study amongst Canadian First Nations people. People’s mass quarantine adherence is determined by housing conditions, poverty and presence of healthcare facilities (3 studies); another study reported that community leaders could not respond effectively to an outbreak, despite disease awareness, without functioning healthcare. High adherence with quarantine was attributed to the presences of on‐site healthcare personnel within the village (1 study); another indicated that community‐based peer education, together with improved communication infrastructure, might reduce negative quarantine impacts. Food insecurity (8 studies): Mass quarantine‐induced mobility restrictions impacted every step of the food supply chain, for instance affecting harvesting and subsequent supply, limiting or delaying transportation. One study reported that villagers disobeyed quarantine orders because of their intermittent food supply, with others reporting concerns about storing food (their own, or those in financial difficulty) during mass movement restriction (2 studies). Food access during quarantine varied across countries (e.g. inaccessibility levels were 4% in one Canadian study but 50% in another Liberian study); with some noting that quarantine disrupted traditional mutual support between villagers, leaving those in isolation without support and food. Two studies reported that most respondents indicated that governments should supply basic needs to those in quarantine, including food and shelter, to improve food security. Economic challenges (7 studies): By limiting personal movement and goods transportation, mass quarantine economically impacts both businesses and individuals. Business impacts can include interruption of the food supply chain, including effects on both domestic and international agricultural trade; and effects on restaurants, tourism and travel‐related businesses (3 studies). For individuals, economic impacts can include reduced income, unemployment and concerns about additional employment costs. Lost or reduced income due to missing work may affect a substantial proportion of people (2 studies), and unemployment leading to loss of income was also identified as the primary concern of people during SARS and EVD outbreaks. People who work part‐time or are self‐employed may be particularly vulnerable if the government delays financial support to those under quarantine who cannot work without travel (1 study). A study from Sierra Leone reported that residents were unable to work due to village‐based quarantine, and that this impacted the labour supply and agricultural cycle. Studies on balancing the economic implications of quarantine have suggested that closing ‘non‐essential community workplaces’ might be one way to reduce expenses for compensating employees who are under quarantine (1 study); another reported that the majority of people (88%) believed that quarantine orders should be followed regardless of employment status but that most (68%) also believed that governments should compensate people for lost earnings during quarantine (1 study). Diminished access to healthcare (6 studies): Access to healthcare was affected by reallocation of resources to the outbreak emergency and by widening health inequality in vulnerable populations, but this varied across contexts. For instance, some informants in a study in Liberia reported increased deaths and complications from preventable diseases as most medical facilities within travelling distance were closed; but another study in Liberia (n = 9) reported full access to medical care for sick family members, supported by government medical transportation services. Other studies reported that some people under quarantine lacked access to prescriptions and health services (2 studies). Three studies found changes to health‐seeking behaviours during quarantine, such as reduced visits to nutrition screening and seeking help from unverified sources. One study reported a dramatic shift in public health priorities to EVD management (over screening), indicating reduced screening due to movement restrictions, behaviour changes in users due to lack of trust, and resource scarcity or competition between EVD management and humanitarian nutrition programmes, both of which were critical for people’s survival. Disrupted education (4 studies): Children and adolescents were affected by school closures, but this varied across countries and outbreaks: some reporting no schooling and others reporting homeschooling by parents. Others in Canada reported that parents might be able to provide homeschooling if both schools and workplaces were closed in mass quarantine; and adolescents reported that they could learn remotely given web‐based learning platforms and mobile connections. Gender inequality and violence (3 studies): Mass quarantine may worsen gender inequality and gender‐based violence. Studies reported inequality in housework and caring responsibilities, with women regarded as default caregivers of sick family members at home, and perhaps delaying their own hospital treatment due to family care responsibilities (1 study). Another reported increasing domestic violence rates against women, while one further reported (approximately 3‐fold) higher rates of psychological disorders amongst men in quarantine. Recommendations: Several negative effects of mass quarantine were identified; the only positive effect identified was altruism. Since mass quarantine can lead to several negative social consequences and may worsen existing inequalities, a focus on reducing social inequalities should be a priority for countries to build resilience and preparedness for future outbreaks. Authorities should implement specific interventions and equity‐based strategies to mitigate socioeconomic implications and mental health impacts of mass quarantine, and clearly tackle social inequalities during mass quarantine and in preparation for lifting such restrictions. Negative social consequences of mass quarantine, such as poor psychological outcomes, can exacerbate existing inequalities or determinants of health. Negative effects may disproportionately affect people experiencing financial hardship, those who are unemployed, or who cannot work from home. Limited access to overloaded healthcare services may also worsen psychological effects, inhibit consultations for those with existing conditions, and substance abuse may be left untreated. A sense of altruism was a positive consequence of mass quarantine; authorities may promote altruism by developing culturally competent, context‐specific strategies; promote use of digital technologies to increase healthcare capacity and harness technology to better enable social connectedness amongst populations. Negative impacts of mass quarantine included reinforcing stigma against minority populations, increased misinformation, and lowered trust in authorities. Such effects have exaggerated existing communication inequalities, which may be negatively associated with outbreak preparedness; these have been compounded by poor information governance across authorities (e.g. no rationale for decision‐making, inconsistent information and instructions and lack of coordination of mass quarantine). Authorities can improve communication by designing equity‐based communication messages (such as information tailored to individual needs based on age, educational level, language), based on accurate data and measures adjusted for risk of disease, consulting community representatives (e.g. those from social minority groups) in developing supplementary measures to lockdowns, and learn from examples of successful misinformation curbing. Community engagement, transparency and tailored strategies to address misinformation are key elements of communication inequality mitigation. Responses should also aim to mitigate existing social disparities (e.g. those for women or ethnic minorities) and respond to needs of vulnerable populations identified directly. Negative effects of mass quarantine may more heavily burden countries unprepared for public health emergencies. For instance, food insecurity may lead to panic buying in high‐income countries but to population‐level famine in low‐income countries; similarly, remote learning may be feasible in urban centres but not for those living in poverty, or in remote areas with poor digital infrastructure. Interventions are therefore needed to address existing disparities as well as those worsened by mass quarantine.	Communication purpose: Findings may inform authorities’ planning and implementation of mass quarantine, including communication to inform populations of measures and to support them in practical terms. Related to review questions: Mass quarantine has several negative effects on society and may worsen existing inequalities. Communication strategies to engage with and inform populations about the measures therefore needs to explicitly address such communication inequalities. Communication between authorities and the population should provide clear, accurate and consistent information; actionable messages; and these must be tailored to different groups within the population (e.g. those of lower health literacy or minority racial groups). Introducing mass quarantine needs to recognise the unintended negative effects of such measures upon the population, and that vulnerable groups may be disproportionately affected. This may require tailored or intensified support (e.g. financial support, food, family violence support and other necessities) to be provided to some or all of the population under quarantine. Strengthening of health systems, and associated support (e.g. access to psychological support) is also indicated.
ECDC 2020b# Citation type: GL Guidance on infection prevention and control of COVID-19 in migrant and refugee reception and detention centres in the EU/EEA and the UK (europa.eu) June 2020 Public health measure: Isolation, and also maps onto quarantine, and crowd avoidance Mapping to Uptake, acceptability, adherence, feasibility Mapping to: Theme 1: features of public communication: content, timing and duration, and delivery Theme 2: recipients of public communication: audience, setting and equity Theme 4: community engagement to support communication Theme 5: public trust and perceptions	Overview and aim: To describe measures for prevention and control of COVID‐19 for refugees and migrants (including asylum seekers and others) living in reception and detention centres Type of study and data: GL (technical report) Included disease(s): COVID‐19 Timing: None specific Countries included: EU/EAA and UK Higher‐income countries Intervention or phenomenon of interest: Communication to support preventive health measures in refugee/migrant detention centres Quality assessment: AGREE II: scope and purpose 86.1%; rigour of development 12.50%; editorial independence 25% Funding source: Not reported	Reported on: Vulnerabilities of migrants and refugees living in reception/detention centres are heightened by the COVID‐19 pandemic, and migrants may be at increased risk of communicable diseases for reasons such as limited healthcare access, low socioeconomic status, lack of vaccination, and poor living conditions (including overcrowding, poor living conditions). Although physical distancing measures be difficult to implement in migrant reception/detention settings (due to overcrowding or lack of facilities), physical distancing principles for the community should be applied and promoted in these settings. Early detection of cases is critical, particularly in overcrowded settings, and this depends on clear communication of symptoms to residents and staff. Multilingual signage (information/infographics with pictograms) should be available about signs & symptoms and what to do if symptomatic, while leaflets and SMS messages should also be considered. Close contacts should be promptly identified and instructed to self‐quarantine and advised what to do if they develop symptoms. Rumours and misinformation may increase fear and anxiety, as could a lack of readily available accurate information available in people’s own languages. Isolation and quarantine may also worsen mental health, and access to mental health and psychosocial services must be provided as essential services for those in migrant and refugee settings. PD should only be implemented in these settings based on proven or presumed infections. Inclusive risk communication and information is required to provide migrants with accessible information from trusted sources, with regular updates, in appropriate languages. Information should include that on evidence‐based prevention of COVID‐19, messages to promote psychosocial well‐being, as well as how and where to seek support. Community leader engagement can also help to raise awareness of and coping with mental health issues. Risk communication and community engagement: Communication about COVID‐19 risks and prevention measures requires strategies that are adapted to meet language, cultural and literacy needs of different population groups housed at such centres. Community engagement (e.g. local influencers, trusted organisations) is a key component of effective communication strategies; helping to build trust, ensure cultural appropriateness of messages, tailor messages, and facilitate better communication and understanding of messages. Accurate, reliable, up‐to‐date information about prevention and control need to be adapted and translated to relevant languages; pretested for cultural appropriateness; visual communication should be adopted (i.e. infographics or photos) to help overcome literacy barriers; and be communicated via a range of channels (e.g. radio, SMS, videos, multilingual hotlines, loudspeaker messages within camp settings), in addition to written information to improve accessibility of the information (particularly in areas of low connectivity). Actionable messaging: Messages should clearly focus on what people are able to practically do to reduce their risk, and what steps they should take if they suspect they might have COVID‐19. Strategies might include working with community leaders to promote appropriate behaviours in the context of reception/detention centres, as well as signposting, practical instructions, and linking behaviours to social norms. Research efforts should be used to gather information about culture, trusted information sources (e.g. social media posts, government statistics and reports), health literacy levels, and health‐seeking behaviours, risk behaviours and prevention barriers; and might include formative sources (e.g. focus groups, interviews). Mapping exercises can help better understand leaders and influencers within communities. Addressing rumours and fears: Fears, rumours and misconceptions circulating amongst the migrant community can affect preventive behaviours and prevent people from seeking medical care (for COVID‐19 and for routine health issues). These therefore need to be understood and addressed. Addressing stigma and discrimination: Misconceptions also need to be addressed to avoid or minimise stigma and discrimination. Communication efforts should focus on acknowledging the existing concerns and presenting a factual response. Media can have an important role to play in conveying factual information while avoiding stigmatisation, stereotyping or religious or ethnic blaming. Storytelling is one possible approach to provide understanding about refugees’ lives and information about preventive measures in place. Recommendations: Preventive measures like physical distancing may be difficult to implement in refugee/migrant reception or detention centres, due to problems such as overcrowding and lack of facilities. Despite this, physical distancing and other measures should be promoted by providing clear, accurate, understandable information to residents, focusing on actionable messages about prevention and healthcare. Information must be tailored appropriately to language, health literacy and culture, and should aim to address misconceptions or rumours.	Communication purpose: Findings can inform strategies for developing appropriately tailored (to health literacy, cultural background) information to communicate with refugee and migrant populations to reduce risk of COVID‐19 transmission. Related to review questions: Despite the difficulties inherent in implementing preventing measures in migrant/refugee detention centres, the aim should be to enact physical distancing and others measures as well as possible given practical limitations (e.g. overcrowding). Communication is key in such situations, to convey risk of disease and actionable messages about prevention. Information needs to be trusted and tailored appropriately to the audience, which may be assisted by community engagement. Information should address misinformation that might otherwise create a barrier to behavioural changes to protect health.
ECDC 2020a# [Guidance on the provision of support for medically and socially vulnerable populations in EU/EEA countries and the United Kingdom during the COVID‐19 pandemic, 3 July 2020. Stockholm: ECDC; 2020] Citation type: GL Public health measure: Isolation, and also maps onto quarantine, general PD Mapping to: Acceptability, adherence, feasibility Mapping to: Theme 1: features of public communication: content, timing and duration, and delivery Theme 2: recipients of public communication: audience, setting and equity Theme 3: support for individual and population behavioural changes Theme 4: community engagement to support communication Theme 5: public trust and perceptions	Overview and aim: To provide guidance (for civil society, NGOs and national, regional authorities) on major challenges, successes and lessons learned from organisations providing support to medically and socially vulnerable people during the COVID‐19 pandemic Type of study and data: GL: guidance presented as technical report based on triangulation of findings from rapid review and across‐country survey (EU/EEA/UK). Authors noted this is exploratory, rather than exhaustive. Included disease(s): COVID‐19 Timing: Survey completed June 2020; in response to stay‐at‐home measures from March‐May 2020 but in anticipation of further restrictive measures as pandemic progresses Countries included: EU/EEA/UK high income Intervention or phenomenon of interest: Challenges for people living in vulnerable situations during pandemic (medically vulnerable or socially vulnerable) and ways to address these Quality assessment: AGREE II: scope and purpose 75.0%; stakeholder involvement 55.56%; rigour of development 13.5%; clarity of presentation 66.67%; applicability 6.25%; editorial independence 0% Funding source: Not reported	Reported on: [data extraction focuses on findings of the joint review + survey data, not on the separate results of each] The COVID‐19 pandemic has created huge challenges in terms of morbidity and mortality, but also in terms of social and economic impacts. Within populations, some people are much more vulnerable to the effects of COVID‐19 than others. This may be a medical vulnerability (i.e. people at higher risk of death or severe disease e.g. older people, people with underlying medical conditions), a social vulnerability (i.e. vulnerable due to the public health measures put in place to control COVID‐19 e.g. people with long‐term physical, mental, intellectual or sensory impairments, homeless people, ethnic minorities, irregular migrants), or overlapping or accumulating categories of vulnerability which create particularly challenging circumstances. There is need for policy responses that recognise the particular challenges faced by each type of vulnerable population, and that allow a more comprehensive approach to address shared challenges and needs across groups. Some of the challenges identified for people who are medically/socially vulnerable have included: The need for targeted information Difficulties accessing services De‐prioritisation of routine services Stigma and discrimination Legal and financial barriers Information jointly analysed from a rapid review and across‐country survey indicated a range of strategic good practices to better support vulnerable groups during the pandemic, particularly if there are surges of cases requiring reintroduction of restrictive measures (i.e. movement restrictions and stay‐at‐home orders) and their accompanying challenges. Those practices most closely related to communication and physical distancing measures are summarised below. Clear communication between service providers and users: Standard risk communication principles should be used when communicating with service users, including: All information about COVID‐19 should be provided in plain (lay) language, translated into minority languages (including languages that are understood by irregular migrants). Information should be provided in a range of formats, follow accessibility standards, and be disseminated through mass media and digital (as well as written) channels. Tailoring of information, specific to the intended audience, is needed. Ensure that messages are likely to be appropriate (acceptable) and effective (accurately understood) by testing these with members of the target audience. Community engagement: Representatives of vulnerable populations should be engaged throughout the development and implementation of response measures during the pandemic in order to build and maintain trust, to ensure acceptability of approaches, their sustainability and effectiveness, and avoid unintended effects (harms). Engagement and communication should be two‐way, collaborative, and involve mutual listening, as per a partnership model of engagement. Use of online/digital technologies: Online technologies (e.g. video or telephone services, virtual peer support groups, group sites for sharing information and lessons), have been an essential way to provide support during the pandemic, and to assist with continuity of existing services. However, such services may not be appropriate in all cases, for instance: People with some vulnerabilities may still need in‐person services or meetings e.g. some of the most marginalised people do not have access to telephones or computers to connect remotely. Continuing to provide services in person, with physical distancing, is critical. Some people (particularly older adults) lack knowledge of or access to digital technologies. People with visual or auditory impairments cannot easily access all online materials. Access to Internet/phone may be limited for some people (e.g. poor Wi‐Fi). In such cases, other means of reaching people are needed and must be accessible (e.g. by providing financial reimbursement for costs, mobile devices, training). Maintaining social connections: Efforts are needed to ensure that vulnerable people are not socially, as well as physically, isolated. These might include assistance with planning how to keep in touch with family/friends, counselling or psychosocial support, and online group activities. Other key good practices identified include the following: The need to ensure continuity of service provision: services must be able to continue their work with vulnerable people and cope with increased demand during the pandemic; requiring proper levels of staffing, training, support and supervision for the service to be sustainable in the longer term; as well as financial support. Collaboration between national/regional authorities and civil society service providers is needed to coordinate a response. Equity and human rights: ensuring equity helps to ensure good public health practice and health protection. Governments should provide financial aid to all people in need, irrespective of their legal working status (e.g. sex workers) or residency status (e.g. irregular migrants); leaders should speak out against stigmatisation of particular groups in the context of the pandemic; implement quarantine measures proportionately to risk and ensure the rights of those in quarantine are considered. Recommendations: Recognition of and attention to addressing the particular challenges of vulnerable groups during the pandemic is key. Principles of risk communication can inform communication strategies for such groups, and community engagement may critically inform responses developed to support vulnerable people within the population, as well as helping to build trust, sustainability and acceptability of responses. Digital technologies may assist in adapting some support services for vulnerable people; but care must be exercised as lack of easy access to such technologies may otherwise further marginalise people from vulnerable groups. Provision of material, including financial, support is crucial to ensure that routine services are maintained and extended for those experiencing disproportionate effects of the pandemic due to one or more vulnerabilities.	Communication purpose: Findings can inform development of public health communication and information strategies to more effectively and appropriately reach vulnerable groups within the community. Related to review questions: Improving communication and support of vulnerable populations may improve uptake, acceptability and adherence to measures; and may mitigate some of the unintended consequences of PH measures in vulnerable groups within the community.
Mao 2021# Citation type: SR (rapid) Public health measure: Isolation, and also maps onto quarantine, and general PD Mapping to: Adherence, feasibility Mapping to: Theme 3: support for individual and population behavioural changes Theme 4: community engagement to support communication	Overview and aim: To identify models and features of volunteering in the UK during the COVID‐19 pandemic (volunteering defined as giving unpaid help as an individual or through a group, club or organisation, to people who are not a relative) Type of study and data: Rapid SR; qualitative and quantitative; N = 27 (13 reports, 3 briefings, 5 blog posts, 2 newspaper articles, 2 websites entries, 2 peer reviewed journal articles) Inclusion and exclusion criteria: Included: studies of community/volunteering groups, volunteers, community champions; UK only. Diverse research included: peer reviewed articles, reports, briefings, blog posts, newspaper articles, online media. English language only. Excluded: Non‐English language; commentary/review; not empirical or analytical Participant features and numbers, sampling details: Sample sizes varied enormously, depending in part on method e.g. 7 interviews plus 57 survey responses up to approximately 32,000 survey responses. Included disease(s): COVID‐19 Timing: Search for evidence January to October 2020. Results are discussed in terms of timing of lockdowns (early/later) and stage of pandemic. Authors note that the timing of the review (2020) represents a limitation in that findings are only relevant to the relatively early stages of the pandemic. Countries included: UK only; high‐income country Intervention or phenomenon of interest: Community volunteer activities and outcomes during the pandemic Quality assessment: AMSTAR 5/11: [1. No protocol/plan; 2. No mention of screening/data extraction details; 5. No excluded studies list; 8. Quality not integrated with findings; 10. No publication bias assessment; 11. no study COI reported]. Funding source: This work was supported by the UK Research and Innovation/Economic and Social Research Council (grant reference number ES/V005383/1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.	Reported on: Several major topics identified through thematic analysis Volunteering activities: addressing needs: Early in the pandemic, delivery of essential supplies (e.g. food, prescriptions) was dominant; as the pandemic progressed, activities moved towards combating social isolation (e.g. telephone support, online social activities). Following the first lockdown, activities shifted to a wider focus of pandemic impacts e.g. mental health, social benefits, employment (2 studies), including involvement in political action (1 study) e.g. developing a collective approach to address poor housing conditions; and eviction resistance campaigns. In such cases, volunteers were working to meet unmet needs that fall within the remit of public services. Volunteering activities: adapting through digital tool use: Volunteers adapted to changing needs but also changing circumstances that made traditional forms of volunteering challenging – most notably in the change from offline to online volunteering. Many organisations and projects adapted their services rapidly by moving to digital infrastructure; some overhauled their activities to move towards digital delivery (e.g. Facebook‐based interactive youth club), while others adopted online tools to complement their offline activities, with many seeking to combat digital exclusion through activities such as mass leaflet drops. Volunteering models: Lockdown onset saw emergence of a huge number and range of volunteer activities, some emerging spontaneously, others from existing organisations or networks. Three broad types of activities: formal, social action volunteering and neighbourhood support (e.g. shopping for others); different coordinated approaches reflect decentralised (information and decision‐making spread around members) versus centralised (command and control) models. The former may be better able to meet a wide range of needs that might be otherwise unmet, however, lack of leadership may be problematic. In reality, most organisations included elements of different approaches, although informal volunteer networks appear to be thriving during COVID‐19. Volunteer profiles: A new volunteer workforce has emerged during the pandemic, one concentrated in working‐age adults (age group and regions) rather than older groups. Predictors of volunteering include being female, wealth and class (i.e. more socioeconomic advantage); but this varies, and other studies have suggested that volunteering in deprived areas may lack resources despite greater community need. One study reported that certain personality traits (e.g. agreeableness), and social support and engagement, were associated with volunteering during the pandemic; and those volunteers reported higher trust in people to follow guidelines, trust in government, compassion and social connection. Successes, challenges, and determinants of effectiveness: Mutual aid groups played a critical role early in lockdown while public services struggled to deliver services effectively and have led to formation of new networks and knowledge which may prove valuable in later pandemic stages. Challenges also exist, e.g. difficulty maintaining volunteer enthusiasm over time, bureaucratic processes delaying interventions (particularly for larger organisations), or logistical difficulties (e.g. co‐ordination required to scale up smaller schemes). Factors important for sustaining volunteering included allowing volunteers to say no, providing social rewards, and recognising their contribution. An underpinning by community‐led infrastructure may assist with co‐ordination and communication between groups and local authorities and help to ensure that the needs of people not covered by government services are met (e.g. homeless, families with young children). Relationships with authorities: Authorities collaborating with local communities to support activities: good models may include community champion schemes (e.g. volunteers given latest COVID‐19 information and asked to share this with their community, while also feeding back which communications were effective and which were not). Such information might include infographics in a range of languages, with champions connected to provide mutual support. In other cases authorities’ influence on community organisations may be unhelpful, such as seeking to control the organisation and actions of volunteers; failing to support the group (e.g. not sharing relevant information or joint planning). Authorities consulting local communities: consultations with local community groups and volunteers regarding priorities and needs (current or future) may be helpful e.g. studies have identified priorities from such consultation as including ensuring clear advice as communities move out of lockdown, tackling inequalities, and preparing/supporting children to return to school and businesses to reopen. However, consultation must be undertaken with a clear intention of involving groups meaningfully to form strong coalitions and leadership to enact change. Recommendations: Diverse volunteering activities and organisations have been apparent during COVID‐19, reflecting existing community support groups adjusting their activities and scope of their activities and the emergence of new groups to meet needs within communities. Importantly, groups appear to have modified their activities following the first lockdown (earlier section of the research sampling window), with an overall shift from immediate demands towards more structural needs. Social connections, local knowledge and social trust were key factors associated with volunteering. Volunteers also tended to be of working age, women, highly educated and middle class. To date community engagement with volunteer groups has been limited but public engagement and community support have been critical during the COVID‐19 pandemic and are likely to have a key role in future public emergencies.	Communication purpose: Findings may be useful for informing strategies to communicate with communities about isolation and lockdown measures, as well as identifying a range of needs of communities during enactment of such measures. Related to review questions: Volunteer groups and activities are diverse and have a critical role in supporting people during the pandemic, e.g. in relation to adherence to isolation (lockdown). Early activities focused on delivery of essential supplies; later, on overcoming social isolation apparent in many in the community; and after the first lockdown, activities shifted to address wider pandemic impacts and unmet needs of community members. Provision of such supports may assist people to adhere to isolation measures. Volunteer activities and organisations have needed to remain flexible in order to respond the changing circumstances with the prolonged pandemic emergency, for instance moving services to digital delivery or adapting delivery and activities undertaken, while attempting to address issues such as digital exclusion through other communication methods (e.g. mass leaflet drops). New partnerships and knowledge formed through mutual aid groups responding in early stages of the pandemic may be valuable as the pandemic continues but also in future emergencies. Volunteering structures which incorporate leadership together with information sharing and shared decision‐making may be best placed to respond to the wide range of needs that are encountered. Co‐ordination and communication with authorities by a community‐led infrastructure may help to ensure that the needs of those people within the community not met by standard government services are identified and met. People who volunteer tend to show social support and engagement, strong trust in people to follow guidelines and trust in government, as well as social connection. A promising model includes community champion schemes, where volunteers are provided with the most recent information (including infographics in community languages) on COVID‐19 to share with their community, as well as providing feedback from the community to authorities about which communications are effective and which are not. Authorities consulting with community groups may provide helpful information on current or future priorities and needs within the community, for example, that clear advice is available to communities as they move out of restrictions (lockdown), that inequalities within communities are addressed, and that support for children to return to school or for businesses to reopen is provided.
Mobasseri 2020# Citation type: SR (scoping) Public health measure: Isolation, and also maps onto general PD Mapping to: Adherence Mapping to: Theme 2: recipients of public communication: audience, setting and equity Theme 3: support for individual and population behavioural changes	Overview and aim: To review the evidence on issues faced by older people during the COVID‐19 pandemic Type of study and data: Scoping review; 210 included papers; quantitative and qualitative (included guidelines, reviews, epidemiological research, editorials, brief reports etc.) Inclusion and exclusion criteria: Included: all publications on COVID‐19 and older adults (research, reports, guidelines, news articles, and scientific material); English language Excluded: non‐English language papers Participant features and numbers, sampling details: ‘Older adults’; no further details Included disease(s): COVID‐19 Timing: Searches for literature January to end July 2020 Countries included: China, France, US, UK, Italy, Germany, Spain, Australia, Ireland, other. All upper middle‐ or high‐income countries Intervention or phenomenon of interest: Issues for older people living through a pandemic Quality assessment: AMSTAR 4/11: [1. No protocol/plan; 5. No real features of included studies; 6. Excluded studies listed; 7,8 quality not assessed or integrated into findings; 10. Publication bias not assessed; 11. No COI for included studies] Funding source: This study is the part of research project funded by Tabriz University of Medical Sciences (Grant No: 65164) and approved by regional research ethics committee of Tabriz University of Medical Sciences; Approval ID: IR.TBZMED.REC.1398.1278.	Reported on: Six themes identified; those relevant to communication are summarised below. Support and information sources: Support, such as providing services (e.g. meals, telehealth), cost coverage for tests and treatments, financial support and educational programmes for older adults may all be important during the pandemic. Development of guidelines specific to older adults has also been key to inform decisions around shielding to protect health. E‐Health services: Telemedicine services can allow older adults to access healthcare using secure online services and apps, and such services have been introduced in several countries. Social contact may also be delivered via telephone or video call. However, many older people do not have ready access, or know how to use, the Internet or a smartphone (e.g. in the UK, < 50% of people aged 75 years or older have Internet access). Volunteer groups may have a role in supporting older adults to access and use technology. Essential supply access: Access to essential supplies (food, medicines) has been provided to older adults in many countries during the pandemic (e.g. online food ordering, meal delivery, allocated shopping hours for older adults). Many countries have formed volunteer groups to support older adults with out‐of‐home work (e.g. grocery shopping). Physical and mental consequences of self‐isolation: The effects of isolation may be particularly profound for older adults, especially those with an existing mental illness, with increases in several poor outcomes noted. Focused models of care and support may be needed to maintain and improve health and related outcomes in these people. Neglect and age discrimination: During the pandemic, older adults may not have been able to undertake their usual activities, e.g. caring for grandchildren. Negative views and age‐related stigma (e.g. vulnerability to COVID‐19 because of advanced age) has led to loss of such roles for older people in the public eye. Additionally, openly ageist discourses, such as media coverage about expensive care for older adults that portrays their mortality as less important than that in other age groups, may contribute to anxiety in older age groups. Recommendations: Older people have a range of needs, issues and challenges associated with living through the pandemic. These may require tailored services, information and support to improve and maintain people’s well‐being. The media has a key role in educating the public and preventing age discrimination. Telemedicine may be an effective way to deliver healthcare, but older people need support and information to be able to access health or social care online. Younger people can support older people in isolation through grocery delivery, helping with everyday tasks and supporting their use of technology, so they can remain socially connected.	Communication purpose: Findings indicate some specific issues for older adults, particularly related to remotely accessing health or other services, and so may inform strategies to improve support to these people. Related to review questions: A range of services, including access to food and essential supplies, is needed to support older adults during isolation required to protect their health during the pandemic. Although remotely delivered health and social care may assist older people to participate in these activities more readily, many do not have ready access to technology or know how to use it. Information and guidance are therefore needed to enable older people to make use of such services.
Regmi 2021# Citation type: SR Public health measure: Isolation, and also maps onto quarantine, crowd avoidance and general PD Mapping to: [major outcome categories] Acceptability, adherence Mapping to: Theme 1: features of public communication: content, timing and duration, and delivery Theme 3: support for individual and population behavioural changes Theme 5: public trust and perceptions	Overview and aim: Identification of factors associated with implementation of non‐pharmaceutical (NPI) measures (physical distancing, isolation, quarantine) for reducing COVID‐19 transmission Type of study and data: SR; qualitative and quantitative primary research. N = 33 studies included (cross‐sectional (26), 4 qualitative, 2 cohort, 1 case‐controlled study) Inclusion and exclusion criteria: Included: Participants of any age, gender or ethnicity, and healthcare workers; NPIs (physical distancing, isolation, quarantine); all effectiveness studies (RCTs, non‐RCTs, observational) including pre‐prints Excluded: publications lacking primary data Participant features and numbers, sampling details: 116,897 participants in total Explicitly considered older people (over 70 years) and/or those with comorbidity; as well as those ethnic populations in lower SES groups Included disease(s): COVID‐19 only Timing: Searches December 2019 to March 2021. No further consideration of pandemic timing Countries included: 17 countries including the UK (5), China (8 including Hong Kong), USA (4), Germany (3), Italy (3), the Netherlands (2), Paraguay, India, Saudi Arabia, Ireland, Tanzania, Singapore, UAE, Nepal, Sudan, Georgia, Bangladesh Studies across all income brackets (low to high income) but approximately 80% high‐income countries Intervention or phenomenon of interest: Implementation of specific NPIs, and factors (enablers and barriers) associated with these Quality assessment: AMSTAR 7/11: [5. No excluded studies listed/provided; 8. Quality assessed and reported but not linked to results specifically; 10. Publication bias not assessed; 11. No COI for included studies reported] Funding source: This research received no external funding.	Reported on: Identified seven themes on enablers (3 themes) and barriers (4) to NPI measures No enabling themes related to communication specifically; rather focused on effective NPI elements (e.g. behavioural change following NPI measures) Of barriers identified, two relate to communication: Fears and concerns about COVID‐19 (12 studies): included uncertainty about the duration of required measures; growing case and mortality numbers; uncertainty about ability to cope with measures in the long term; lack of trust in public health authorities and the government due to lack of clear information on infection and what measures are effective. One study identified a lack of clear information on physical distancing and isolation in particular and a lack of trust in the media/government. Debatable role of mass media (3 studies): Rumours on social, electronic and print media about measures negatively impacted mental health and reduced ability to cope. Despite many participants being adequately informed about COVID‐19 infection, people were still largely influenced by media information. Further factors affecting adherence (equity implications) (13 studies): COVID‐19 infection associated with people from BAME populations in lower socioeconomic groups, lower economy band employment, comorbidities, exposure risks and older age. Older people (70+) almost twice as likely as younger (18‐24 years) to adhere to NPIs; single people less likely to practice physical distancing. People from more disadvantaged backgrounds less likely to be able to work from home, or to self‐isolate. The most economically disadvantaged were less able to comply with some NPIs, due at last partly to financial needs; a strong association between socioeconomic deprivation and ability to adopt NPIs was noted. Recommendations: Research is needed to better understand and promote adoption of specific NPIs within different countries and contexts, and to further consider the many factors that might influence this including sociopolitical, socioeconomic and cultural factors. Improving factual communication about pandemic risks, and understanding the needs and behaviours of individuals and specific populations are important. There is a need to intensify public awareness, and educate both general and specific populations in order to address the lack of knowledge and/or misconceptions about COVID‐19. Authors recommend utilising Internet‐based information with social media influencers, and education and counselling strategies to address misconceptions and provide support via different stakeholders (governments, NGOs, charities, national volunteers, community support groups). Increased media coverage may be helpful in increasing uptake/acceptance of NPIs. Effectiveness of messaging may be affected by perceived credibility of the source, as well as message content and context.	Communication purpose: Factors (enablers and barriers) may be useful for developing targeted messages and information to target disadvantaged groups, and to consider tailored support for those less likely, or less able, to follow NPI measures. Related to review questions: Clear, reliable information may help to dispel distrust of public health authorities and the media, and to support adoption of behaviours needed to enact NPI measures. Provision of tailored support for those at socioeconomic or other disadvantage may also help people to adopt and adhere to measures.
Seale 2020# Citation type: SR (rapid; not truly systematic) Public health measure: Isolation, and also maps onto quarantine, school measures, and work measures Mapping to: Uptake, acceptability, adherence Mapping to: Theme 3: support for individual and population behavioural changes Theme 6: school measures	Overview and aim: To identify key determinants of community engagement with individual protective behaviours and non‐pharmaceutical measures for COVID‐19, and their impacts on individuals, and to identify behaviour change interventions to promote and support community participation in required measures Type of study and data: Rapid SR; qualitative and quantitative studies; 53 included Inclusion and exclusion criteria: Included: Community settings (general population, non‐healthcare); English language; published, peer‐reviewed research; COVID‐19, SARS, MERS, H1N1, influenza A, hypothetical pandemics; personal protective and environmental measures (data not extracted) and NPI measures (isolation and quarantine, school and workplace measures, crowd avoidance) Participant features and numbers, sampling details: Not reported across included studies; specific examples cited related to described results Included disease(s): COVID‐19, SARS, MERS, H1N1, influenza A, hypothetical pandemics Timing: Searches January to March 2020 (early in pandemic). No specific time‐related factors highlighted. COVID‐19 studies published as of July 2020 were included. Countries included: Not clear for study set as a whole; NPI measure studies mentioned Australia (Aboriginal communities), Canada, New Zealand, Japan, The Netherlands, USA, Taiwan, Liberia. All high income except Taiwan (upper middle‐income) and Liberia (low‐income) Intervention or phenomenon of interest: Community engagement with NPI measures, and effects upon behaviours such as adherence to measures Quality assessment: 3/11 [1. No protocol; 4. Only published literature considered; 5.6 no list or complete characteristics of included studies; 7. No quality assessment or 8. Use in formulating results; 10. Publication bias not assessed; 11. COI for included studies missing] Funding source: There was no funding associated with this study.	Reported on: [N.B. results related to personal protective measures not extracted – outside review scope] Isolation and quarantine: Several factors linked to quarantine adherence; educational level, others’ behaviours, family needs, work and financial commitments; female gender and married status more likely to adhere, younger age groups less likely. Attitudinal factors also influence quarantine adherence; perceived susceptibility or proportionality, perceived efficacy of measures and trust in authorities are all associated with adherence. A major concern is impacts on employment (job security) and income across all income brackets, but particularly concerning to those earning lower incomes, people not paid for time away from work or unable to work from home, and for those living in urban areas, aged 18‐30 years, or with a high school educational level. Concerns also present related to access to essential services (food, healthcare, accessing doctors for evidence of sick leave) unless social and material support were provided; ability to comply with quarantine orders in larger households (more than parents and their children) with limited space (such as in Australian Aboriginal communities), and ability to attend important gatherings (e.g. funerals, caring for sick family or community members). Importance of proportionality of restrictive measures to the public’s perceived risk to foster adherence. Negative effects of quarantine and isolation exist (e.g. stigma, fear, loneliness); these are worsened by inadequate supplies, fear of infection, and inadequate information and communication. Recommendations: NPI measures need to be introduced with practical supports (e.g. financial support, communication systems for contact while in isolation/quarantine). Information to support the measures needs to consider health literacy levels; be written in clear lay language including acknowledgement of the difficulties of adhering as well as information on the impact of measures and how to address or reduce negative impacts. School measures: Parents may be unwilling or unmotivated to adhere to school measures if they do not: understand the reasons for the measures or what is required, believe the closure will have any impact or benefit to the community, or feel that their children are at risk (i.e. low perceived risk). Misunderstanding of term “school closure” was associated with “permitting out‐of‐home activities” i.e. school measure success may be undermined by compensatory contact between children out of school. Communication to the community is needed to support school closures (e.g. sports clubs). Students may not understand advice to avoid contact is to prevent themselves from infecting others. Financial burden on families due to increased childcare and/or work absence during school closures affects adherence but varies across studies. This may be particularly important for those unable to work at home and for single‐parent households. Families may need assistance with caring for children during closures or leave children to self‐care (with attendant risks). Children in self‐care may be more likely to engage in compensatory behaviours. Negative closure effects (particularly longer duration) include those on nutrition (unable to access school nutrition programmes) and disrupted learning. The latter may be mitigated by remote learning, but inequalities may be heightened (e.g. children from lower SES backgrounds may not have ready access to computers/Internet/adults to assist with learning). Conflicting/insufficient information to support parents to home‐school children may compound negative effects. Communication themes: NPI strategies should be proportional to the risk, clearly and transparently communicated to the community, and accompanied by reciprocal support for those adhering to the measures. Low community levels of knowledge of measures or rationale for their use, of how to undertake the measures, or exposure to conflicting information all negatively influence adherence. Communications that emphasise benefits to the community of adhering to measures, reinforce related social norms and that adherence is the socially responsible action to take, may be beneficial. Use a range of media (e.g. social media, posters) to impart information; consider tailored messages to those who are less likely to adhere (e.g. younger men); and targeting different health literacy levels. Recommendations: A key focus needs to be community participation and co‐design of communication messages, materials and delivery of these (outreach) to support community behaviour change (adherence). Clear, consistent information about measures, including rationale for their use and practical ‘how to’ information (what can and cannot be done; who, what, when and where), as well as emphasising benefits of adherence, is critical as NPIs are introduced and implemented. Reciprocal support (social, healthcare, financial supports) is needed alongside communications to promote adherence. Communications need to be tailored to the community, including to lower health literacy levels, and/or to those less likely to adhere to measures. Involving community leaders in communicating key messages may help to build trust and move the community towards action.	Communication purpose: Findings may inform development of communication messages for communities and individuals who are being asked to adhere to NPI measures such as isolation, quarantine and school closures. They may also inform development of tailored communication messages to particular groups within communities, such as those less likely to adhere to measures, or those with lower health literacy levels. Related to review questions: Clear, consistent communication and information about NPIs are needed to support people’s adherence to the required measures. NPI strategies should be proportional to the risk, and communications accompanied by reciprocal support (e.g. social and financial supports) for those adhering to the measures. A clear rationale for the measures needs to be widely communicated so that people accurately understand the risks, and should be accompanied by clear, actionable and consistent information about what people need to do to protect their health. Involving communities in developing and delivering messages to support the required behaviour changes may build trust and improve adherence. Communication and information provision should be tailored to local communities and groups within communities, such as those who are less likely to adhere, and use a range of media (e.g. social media, posters) to optimise reach.
WHO 2020c# At: COVID-19 Global Risk Communication and Community Engagement Strategy – interim guidance (who.int) Interim guidance December 2020 Citation type: GL Public health measure: Isolation, and also maps onto crowd avoidance, and general PD Mapping to: Uptake, acceptability, adherence Mapping to: Theme 1: features of public communication: content, timing and duration, and delivery Theme 2: recipients of public communication: audience, setting and equity Theme 4: community engagement to support communication Theme 5: public trust and perceptions	Overview and aim: To describe components of revised risk communication and community engagement framework and guidance in the context of the ongoing COVID‐19 pandemic Type of study and data: GL: based on series of stakeholder consultations and underpinned by meta‐analysis of 9 databases Included disease(s): COVID‐19 Timing: Nonspecific Countries included: WHO; international Intervention or phenomenon of interest: Risk communication and community engagement elements as key to pandemic PH responses Quality assessment: AGREE II: scope and purpose 52.8%; stakeholder involvement 44.44%; rigour of development 24.0%; clarity of presentation 58.33%; applicability 29.17%; editorial independence 33.3% Funding source: The RCCE Collective Service is a collaborative partnership between RCCE practitioners, convened by IFRC, WHO and UNICEF, with support from the Global Outbreak Alert and Response Network (GOARN), and key stakeholders from the public health and humanitarian sectors	Reported on: Extracted data focuses on RCCE strategy components and purposes related most closely to PD measures for COVID‐19 prevention and control. Revised RCCE strategy reflects shift from directive, one‐way communication to community engagement and participatory approaches that have been successful in control and elimination of past disease outbreaks. The overall goal is to promote person‐centred, community‐led approaches in order to increase trust and social cohesion, and to decrease negative impacts of COVID‐19. Generally, data show that people know about COVID‐19 and the preventive measures needed to protect themselves, but risk perceptions are falling and complacency growing alongside increasing pandemic fatigue and uncertainty and falling confidence in ability to control the pandemic. Uptake of protective behaviours and adherence to measures will continue to be critical to controlling COVID‐19 even with effective vaccines and treatment; therefore strengthened RCCE will be critical to improve knowledge, acceptance and uptake of measures. Community engagement is key to understanding local contexts and ensuring an informed, appropriate (person‐centred) response, without which misinformation, confusion and mistrust can undermine public health efforts. Pandemic fatigue is growing and is likely to lead to fewer people being motivated to follow recommended preventive behaviours, and can be influenced by several factors including: lowered disease risk perceptions, increased socioeconomic and psychological impacts of the pandemic and restrictions, stress of uncertainty, becoming used to living in a pandemic situation and decreased trust in authorities. Importance of engaging stakeholders to design and implement communication strategies is emphasised, alongside mechanisms for feedback from stakeholders (which underpins effective two‐way communication and engagement). Meta‐analysis of multiple datasets identified the following related to communication and physical distancing measures: Basic knowledge about COVID‐19 is good and improving (e.g. knowledge about symptoms), but risk perceptions of COVID‐19 as a disease are falling (e.g. believing the pandemic over, or that others in community are more likely to contract the disease). Lower knowledge levels are associated with lower adherence to measures, but factors affecting knowledge vary across countries and regions. Globally most (68%) people trust information from doctors/scientists, 56% from WHO. Trust is a key determinant of behaviour; with variability in trust of politicians (possibly due to historical or structural factors, lack of transparency). Channels of information provision should be contextually appropriate; and high exposure to a particular information channel does not necessarily correspond with high levels of trust of information received via the channel, e.g. while use of online sources is growing, trust in those channels is typically low. Self‐efficacy (confidence) in ability to prevent COVID‐19 is low (50% or lower). In countries with lower self‐efficacy levels, people are less likely to practice preventive measures. Additionally, people are more willing to act to prevent disease if included in decision‐making processes related to the COVID‐19 response. Worsening inequalities, with the pandemic affecting the poorest and most vulnerable disproportionately. Stigma and discrimination leading to marginalisation of minority or foreign population groups, which can slow or prevent efforts to prevent spread of COVID‐19. Engaging with affected communities is imperative so that they can lead and deliver local responses wherever possible. Adherence to personal preventive measures (e.g. keeping physically distant) is generally high, although physical distancing is generally adhered to less often than other measures such as handwashing. Adherence is also lower for those measures that restrict economic activities, and food insecurity risk and income loss can affect adherence. Measures that limit public gatherings show limited adherence, and this is influenced by traditions, sociocultural norms and need for social interactions. Physical distancing uptake and adherence is influenced by structural factors (e.g. social context, personal circumstances) as well as people’s access to space. Perceived norms are an important factor but vary across countries, as are other factors such as carer responsibilities (e.g. lower levels of distancing because of need to care for others outside the home). Physical distancing measures are also determined by personal characteristics such as socioeconomic status and gender (e.g. men tend to leave the house to socialise more often than women, risk may be more common in those with fewer resources). Adherence to self‐isolation measures is lower than for other personal preventive measures. There is confusion about the terminology (isolation, quarantine, shielding) that needs to be clarified globally. Informal mechanisms predominate where support for vulnerable people shielding is needed e.g. in LMIC, families and households take on primary responsibility for care of the vulnerable; these can be extended by kinship and mutual aid groups within communities. Voluntary shielding approaches appear more effective than mandated. Economic impact on households (e.g. loss of livelihood, unpaid caregiving by household member) can be a barrier to shielding the most vulnerable. Acceptability of PHSMs is generally high globally, but pandemic fatigue and/or loss of trust in authorities or governments can become a barrier to supporting the measures or lead to protests and disruption to civil society. There are secondary health impacts of the pandemic which are identified globally e.g. difficulties in access and/or timeliness of care for non‐COVID‐19 illnesses. Objectives of RCCE include: Community‐led: with communities assessing own needs and participating in planning, design, implementation, monitoring, and evaluation of local COVID‐19 responses. Strategies to achieve this include provision of guidance and tools for best‐practice community engagement; develop strategies to address stigma/discrimination, pandemic fatigue and to build trust; coordinate efforts to manage the infodemic and build health and digital literacy; balance digital and in‐person engagement to ensure vulnerable people are not left behind. Reinforce capacity and local solutions to control the pandemic and mitigate impacts through mentoring, technical support and resource sharing with local groups. Local expertise should be explicitly recognised and should be central to community engagement efforts (building on existing relationships and established trust). Aspects to consider include: the required skills needed in different contexts should be identified and include participatory approaches, facilitation and co‐ordination and data collection/analysis; requirements for technical support and capacity building; opportunities and requirements for training, training resources (adaptable to language, format, accessibility); strengthen capacity for local and national media to identify and address misinformation. Work collaboratively: via strengthening of co‐ordination at different levels and promoting partnerships with local groups (community‐based organisations, local governments, communities themselves) to identify localised community‐centred responses. Strategies to achieve this include convening multi‐stakeholder groups to broker partnerships and coordinate RCCE; identifying organisations involved in engaging communities and particularly vulnerable groups; integrate RCCE into all response efforts for COVID‐19 to ensure coverage and prevent duplication of effort, and to promote sharing of resources, evidence and expertise. RCCE efforts need to prioritise the most medically or socially vulnerable, with many different groups identified, including: Older people (> 60 years): who may be unable to access adequate information and health services; need support of caregivers; not understand public health information; have difficulty physically distancing (e.g. assisted living facilities). People with pre‐existing medical conditions: who may not have access to information about why they are at heightened risk. Children/young people: may not have access to information or understand required behaviours and may be amongst the most affected by preventive measures (e.g. school closures). Ethnic/monitory populations: may not have ready access to information in own language, or face stigma/discrimination in healthcare settings. Disadvantaged populations (e.g. gender‐based violence survivors, homeless, mental health conditions, sexual and gender minorities, women and girls): who may face disruption of services/support; isolation; lack of understanding of information on preventive measures; exclusion from decision‐making; restricted access to information due to limited education and language‐learning opportunities. People deprived of their liberty (e.g. prison, detention centres): may have limited information or opportunities to ask questions and lack trust of facility staff and information. People living within humanitarian crises (e.g. refugee camps): access to essentials (e.g. shelter, food, protective supplies) may be disrupted; and timely and accurate information may be lacking due to isolation or language barriers. People living in overcrowded spaces (e.g. slums, dormitories, urban poor): physical distancing may be difficult with overcrowding/movement of people between dwellings; may be higher levels of distrust of government; lower levels of education and health literacy, all of which may impede access/understanding of public health information and required measures. People with disabilities: amongst the most marginalised (i.e. live in poverty, higher rates of violence, neglect and abuse); excluded from decision‐making; unequal access to information or available services (particularly those with specific communication needs). People working in confined conditions (e.g. factories, abattoirs, meat‐packing plants) or informal economy: may be unable to follow physical distancing measures and/or measures may be poorly regulated. Public health information may not be readily available. Refugees and migrants: may face legal hurdles, discrimination and language barriers which prevent understanding of public health information; may not be included in national response plans; and may be difficult to reach (i.e. mobility which may include cross‐border movements). Major themes anticipated in immediate‐to‐medium term future (with relevance to communication for physical distancing measures: Uncertainty will continue: clear, consistent public health communication that acknowledges this can help to mitigate the impact of uncertainty (and does not undermine trust). Building and maintaining community trust is essential; it is built from sustained community engagement that is evidence‐based, communicated via trusted sources, and responsive to community feedback but requires structures and processes (e.g. participatory governance, mechanisms to involve communities in policy and intervention design) in place. Community engagement to overcome politicisation of the pandemic response (e.g. conflicting messages from leaders); and community engagement to answer questions and provide clear, accessible information from trusted sources in community languages, via a range of channels preferred by the community. Effectively engaging communities can also help to prevent and stop stigma and discrimination. Economic pressures will continue to grow, forcing people to take greater risks, such as having to decide between following PHSMs and earning enough money to survive. Effective RCCE can help to engage those who are economically vulnerable and provide opportunities for them to identify locally appropriate responses that reflect their economic and social needs. Recommendations: Global trends in knowledge, perceptions, fatigue and related factors (e.g. economic impacts) indicate that effects of the pandemic are many and complex and make effective communication to increase PHSMs uptake challenging. RCCE and community engagement are key to promoting PHSMs and to addressing problems evident across communities and populations worldwide. At its heart, this should engage communities in two‐way dialogue to support locally appropriate processes, interventions and mechanisms to support and sustain implementation of required PHSMs. This should include deliberate consideration and engagement with those who are vulnerable (of which there are many) and work to ensure that engagement is representative of local communities. Co‐ordinated efforts to tackle misinformation will be critical, as this can lead to poor adherence to public health advice (as well as increase stigma and adversely affect health), which limits the effectiveness of the measures in countries’ pandemic responses. Pandemic fatigue will increase with the continuation of the pandemic, and better understanding is needed of the effects of this, e.g. people’s efforts to follow preventive measures may fall, their efforts to stay informed may also fall. Identifying and creating ways to engage and motivate people by partnering with local groups and leaders may help to improve motivation and therefore adherence to measures.	Communication purpose: Findings may inform effective communication and engagement strategies and processes to address both existing and emerging issues (e.g. pandemic fatigue, economic and social pressures) experienced by people across the world that can impact on uptake and adherence to PHSMs to prevent and control COVID‐19. Related to review questions: Many factors affect adherence to physical distancing measures. Some are structural or practical; others reflect sociocultural factors within local communities and populations. Community engagement and clear communication and information may assist with addressing some of the identified barriers to adherence to measures.
Primary studies
Burnet 2020a# (primary) Mapping to: Adherence, also to acceptability Also relevant to public health measures 3 (quarantine) and 6 (crowd avoidance)	Overview and aim: Exploration of Australians’ experiences of self‐isolation/quarantine and barriers and enablers to successful self‐isolation/quarantine Inclusion and exclusion criteria: Included: Adults (20 to 73 years), self‐isolating (or have done so) in Australia after being instructed to by a health or government authority Types of study and data: Primary qualitative study Countries included:Australia Quality assessment: 6/10 CASP score (recruitment strategy not reported; no referral to researcher/participant relationship; ethics approval not reported; no primary quotations used, analysis method not stated, coding framework not included)	Reported on: Communication Service provision (basic services, mental health crisis, financial support). Communication: Socially isolating participants were highly motivated to ‘do the right thing’ but were uncertain about what to do to comply with self‐isolation/quarantine measures requested. Provided information was inadequate (confusing, unclear, contradictory), with confusion about physical distancing requirements compared with self‐isolation. This may lead to non‐compliance with measures. People in home‐based quarantine are turning away from government announcements as they perceive them as incomplete (not presenting evidence/whole story), impractical or unhelpful, inadequate (lacking hard and fast rules) and having a finger pointing/shaming tone (and people have a lack of support). People perceive government inaction as de‐motivating when self‐isolating, and they don’t see an adequate government response on a population level. People felt their isolation was not contributing to reducing transmission because of government inaction and lack of support. Service provision/support: Participants reported limited support or follow‐up contact by government to determine whether they were self‐isolating and whether they required support to do so. Ensure people have access to basic services (including food, medication, activities) to support their period of isolation. Most participants relied on family and friends, with little support from services, which can make people vulnerable and decrease compliance to the required measures. Expanded mental health services during home‐based quarantine are needed, as people are at higher risk of new or recurring problems, exacerbated by the population’s uncertainty about the pandemic and response to the pandemic. Participants indicated they needed immediate support but did not know how to access channels of support. For many people, job security has been lost during home‐based quarantine, and this will increase over time. Difficulties accessing financial support while in isolation causes distress and non‐compliance with required measures and may lead to people talking additional risks once quarantine is completed in order to survive financially (e.g. continuing to work in close contact with people despite lack of physical distancing measures). Recommendations: Enhance immediate and ongoing communications to promote better knowledge about required self‐isolation/quarantine measures, including information to make the distinction between these measures and physical distancing measures clear. Create and disseminate consistent central information using lay language and incorporating practical information about initiation of measures, compliance, and services available to support the measures (including mental health services). Develop better ongoing support to enable people to be as compliant in home‐based and community‐based quarantine as possible, while reducing long‐term physical and mental health effects. This includes easily accessed food, medication, mental health services and financial support. This will be particularly important for those who are in home‐based quarantine without all the immediate government supports. Communicate the availability of these support services widely. Communicate about home and community‐based quarantine in a supportive, ‘no blame’ manner.	Communication purpose: This may inform communication with individuals who have been asked to self‐isolate or are in quarantine to adhere to health or government authority requirements. These findings may also inform communication with communities about preparing for, or complying with, isolation or quarantine. Related to review questions: Findings show that individuals’ perceptions and experiences of self‐isolation and quarantine are affected by their access to clear information. Lack of information, contradictory/confusing information or difficult‐to‐find information about what people can and cannot do while in isolation/quarantine was related to non‐adherence. Access to basic services for those in isolation/quarantine must be assured, and information about these services communicated widely, including about mental health services and financial support, and how to access these services.
Burnet 2020# (primary) Mapping to: Adherence (primary) but may also map to acceptability Also relevant to public health measures 3 (quarantine) and 6 (crowd avoidance)	Outcomes and aim: Exploration of Australians’ experiences of self‐isolation/quarantine and barriers and enablers to successful self‐isolation/quarantine Intervention or phenomenon of interest: Adults (18 to 73 years), self‐isolating (or have done so) in Australia after being instructed to by a health or government authority Types of study and data: Primary qualitative study Countries included: Australia Quality assessment: 6/10 CASP score (recruitment strategy not reported; no referral to researcher/participant relationship; ethics approval not reported; some primary quotations used but analysis method not stated, coding framework not included)	Reported on: Communication Access to information Service provision Preparedness Findings reported here focus on social distancing measures and communication. Communication and information access: Fear and a lack of clear advice is driving symptomatic (COVID‐19) people to travel back to Australia without reporting symptoms, as they do not trust they will be supported to return home, and they do not understand Australian government policy. Community‐level plain language information must be communicated about transmission risks in those transitioning from quarantine to physical distancing and aiming to reduce stigma (rights and responsibilities assured) in order that people can safely transition out of quarantine and physical distancing restrictions. Information materials may include discussion scripts (e.g. for employers, colleagues, family). Community‐level stigma based on fear of disease transmission may inhibit contact tracing and testing, so reducing effectiveness of public health measures. Service provision: Families and pregnant women tested for COVID‐19 reported not receiving mental health assessments and support despite the presence of pre‐existing and acute mental health issues, running the risk of exacerbation of current illness or new pathology. Assure people they will receive appropriate support, including food provision, maternal and child checks and mental health services. Recommendations: Key recommendations to improve compliance with quarantine and reduce negative population‐wide health effects include: Improved communication and information about home‐based quarantine, including practical information, such as FAQ to support decision‐making and service provision. Develop and communicate officially the range of specific support services available to people in quarantine, e.g. how to access food and medication, financial supports, and mental health services. Acknowledge the difficulties of quarantine by providing moral support to individuals undergoing home‐based quarantine and supporting them to complete quarantine. Encourage and support people (through information) to develop quarantine plans ahead of time.	Communication purpose: This may inform communication with individuals who have been asked to self‐isolate or are in quarantine to adhere to health or government authority requirements and also clarify transmission risks once quarantine is complete. These findings may also inform communication with communities about preparing for, or complying with, isolation or quarantine and also transmission risks once recovered from COVID to reduce stigma. Related to review questions: Better communication and information about home‐based quarantine, including practical information, are needed to support people’s adherence to required measures. Access to support services for those in self‐isolation/quarantine must be assured, and information about these services communicated clearly, including mental health services, maternal and child checks and financial support, and how to access these services. Community‐level plain language information must be communicated about transmission risks in those transitioning from quarantine to physical distancing and aiming to reduce stigma so that people can safely transition out of quarantine. People with COVID experience stigma due to fear of community transmission and which may potentially negatively impact testing and contact tracing, so threatening the effectiveness of public health measures.
Farooq 2020# (primary) Mapping to: Uptake Also relevant to general PD measures, particularly crowd avoidance	Outcomes and aims: Investigates the impact of cyberchondria (continuous impulses to go online and read about concerning health topic) and information overload on voluntary self‐isolation intention Intervention or phenomenon of interest: Study develops and tests a model based on protection‐motivation theory to identify whether intermediate constructs (related to threat appraisal and coping appraisal) are impacted by cyberchondria or information overload and then influence self‐isolation intention. Inclusion and exclusion criteria: Included: Students, faculty, and employees of a university Type of study and data: Questionnaire‐based survey; 225 respondents; (March 19, 2020) using online survey tool Webropol. Descriptive statistics for all survey measures Countries included: Finland Quality assessment: Response rate: + representativeness: + COI: authors declared no COI exists; participants were geographically (Finland) and socially limited (students/staff of a university); pre‐print paper (not peer‐reviewed)	Reported on: Cyberchondria and information overload affected individuals’ threat and coping perceptions, and through them, self‐isolation intention. Perceived severity and self‐efficacy positively influenced intentions to self‐isolate, whereas response cost had a negative effect. Cyberchondria increases threat appraisals through perceived severity and vulnerability. Perceived severity in turn is related to increased self‐isolation intention, but perceived vulnerability is not. Information overload reduces coping appraisal (assessed via self‐efficacy) and increases coping appraisal (assessed via perceived response cost). In turn, self‐efficacy increases self‐isolation intention whereas perceived response cost reduces self‐isolation intention. Social media as the primary information source increases both cyberchondria and information overload compared to other sources. Recommendations: Generally, cyberchondria and information overload are regarded as negative consequences of online information, however, during the COVID‐19 pandemic, they may indirectly contribute to self‐isolation intention. Sourcing information primarily from social media increases both cyberchondria and information overload. Recommended personalising communication by providing: 1) reassuring/hopeful messages targeting individuals experiencing cyberchondria; 2) communication aiming to increase perceived severity of the situation targeting those with no intention to self‐isolate; 3) clearly structured communication using reliable health information targeting those experiencing information overload.	Communication purpose: Findings may be useful for enabling communication; facilitating decision‐making and supporting individuals’ behaviour change in relation to uptake of physical distancing behaviours (intention to adopt self‐isolation). Related to review questions: Findings link information provision (cyberchondria and information overload) to perceived threat and appraisal of coping and through them, influences intention to self‐isolate. Findings suggest that clear, tailored communication targeting particular groups may help to counteract some of these effects, particularly associated with social media as the primary information source, and so positively influence intention to self‐isolate.
Qazi 2020# (primary) Mapping to: Uptake Focused on general PD measures particularly crowd avoidance	Outcomes and aim: Effects of formal and informal information sources on situational awareness (perceived public understanding) to predict adoption of PD measures during COVID‐19 Inclusion and exclusion criteria: Included: Adults 18 years and older Type of study and data: Questionnaire‐based survey; 210 responses. Formal information sources (e.g. newspapers, press releases, educational messages) and informal sources (social media, peer and family views) Countries included: Unclear, likely Pakistan Included disease(s): Specific to COVID‐19 but based on same theory used for SARS outbreak analysis Quality assessment: Response rate: + representativeness: + authors declare no COI; people with lower computer skills/access underrepresented; paper published (peer reviewed)	Reported on: Formal information sources included newspapers, press releases, educational messages, while informal sources included social media, online reviews and family or peer views. Both formal and informal information sources affected perceived understanding. Perceived understanding in turn is related to physical distancing behaviour adoption. Recommendations: Formal and informal information sources influence public situational awareness. This in turn increases adoption of preventive behaviours (physical distancing). Formal sources are associated with greater compliance with physical distancing measures; informal sources may not be influential until preventive behaviours have been adopted by the community.	Communication purpose: This may guide communication with communities to prevent transmission through adoption of public health measures (physical distancing). Related to review questions: Findings link information provision through informal and formal routes to changes in perceived understanding, and with adoption of physical distancing measures.