Challenges of self-isolation among contacts of cases of COVID-19: a national telephone survey in Wales

BACKGROUND: Self-isolation is known to be challenging and adherence is dependent on a range of psychological, social, and economic factors. We aimed to identify the specific challenges experienced by contacts of COVID-19 cases to better target support and minimise the harms of self-isolation. METHODS: The Contact Adherence Behavioural Insights Study (CABINS) was a 15 min telephone survey of contacts of COVID-19 cases, identified through NHS Wales Test Trace Protect (TTP). Quota sampling by age, gender (interlocked), and Welsh Index of Multiple Deprivation (WIMD) was used to ensure a representative sample of those in the TTP database. Logistic regression models adjusted for age, gender, living alone, time period, WIMD, and income precarity (financial insecurity) established which subgroups were more likely to experience challenges. Ethical approval was gained from the NHS Research Ethics Committee and the Public Health Wales Research and Development Office. Informed consent was gained from participants at the beginning of the telephone call. FINDINGS: We identified 47 072 eligible contacts (24 825 female, 23 090 male, and 10 542 did not say) who were informed to self-isolate over two periods (period 1 [regional lockdowns in place; no financial support available]: Sept 13, 2020, to Oct 23, 2020 [n=18 568]; period 2 [during a national lockdown; self-isolation support payments available]: Dec 13, 2020, to Jan 16, 2021 [n=28 504]). 10 801 were invited to participate (5092 from period 1, 5709 from period 2); 2027 (18·8%) completed the survey. People with high income precarity were almost eight times more likely to report financial challenges (adjusted odds ratio 7·73; 95% CI 5·10–11·74) and three times more likely to report mental health concerns (3·08; 2·22–4·28) than their more financially secure counterparts. Younger people (18–29 years) were twice as likely to report loneliness (1·96; 1·37–2·81) and three times more likely to report mental health concerns (3·16; 2·05–4·86) than individuals aged 60 years and older. Women were nearly twice as likely to experience mental health difficulties as men (1·51; 1·20–1·92). No effects of WIMD were found. Findings were similar between the two periods. INTERPRETATION: Financial challenges of self-isolation were particularly acute among those individuals with high income precarity, and younger people and women had considerable mental health challenges. During the pandemic, Welsh Government and local TTP teams used this insight to target financial and mental health support to those with greatest need. Despite easing of self-isolation requirements for contacts of COVID-19 cases, identifying these groups remains important for future pandemics and the provision of financial and social support. FUNDING: Project funded internally by Public Health Wales.