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Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study

Alison Porter Orcid Logo, Ashley Akbari Orcid Logo, Andrew Carson-Stevens, Jeremy Dale Orcid Logo, Lucy Dixon, Adrian Edwards Orcid Logo, Bridie Evans, Lesley Griffiths, Ann John Orcid Logo, Stephen Jolles, Mark Kingston Orcid Logo, Ronan Lyons Orcid Logo, Jennifer Morgan, Berni Sewell Orcid Logo, Anthony Whiffen, Victoria Williams, Helen Snooks Orcid Logo

BMJ Open, Volume: 13, Issue: 8, Start page: e073464

Swansea University Authors: Alison Porter Orcid Logo, Ashley Akbari Orcid Logo, Bridie Evans, Ann John Orcid Logo, Mark Kingston Orcid Logo, Ronan Lyons Orcid Logo, Berni Sewell Orcid Logo, Victoria Williams, Helen Snooks Orcid Logo

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DOI (Published version): 10.1136/bmjopen-2023-073464

Abstract

Introduction: Shielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the first year of the pandemic from March 2020. As the first stage in the EVITE Immunity evaluation (Effects of shielding for vulnerable people during COVID-19 p...

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Published in: BMJ Open
ISSN: 2044-6055 2044-6055
Published: BMJ 2023
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As the first stage in the EVITE Immunity evaluation (Effects of shielding for vulnerable people during COVID-19 pandemic on health outcomes, costs and immunity, including those with cancer:quasi-experimental evaluation), we generated a logic model to describe the programme theory underlying the shielding intervention. Design and participants: We reviewed published documentation on shielding to develop an initial draft of the logic model. We then discussed this draft during interviews with 13 key stakeholders involved in putting shielding into effect in Wales and England. Interviews were recorded, transcribed and analysed thematically to inform a final draft of the logic model. Results: The shielding intervention was a complex one, introduced at pace by multiple agencies working together. We identified three core components: agreement on clinical criteria; development of the list of people appropriate for shielding; and communication of shielding advice. In addition, there was a support programme, available as required to shielding people, including food parcels, financial support and social support. The predicted mechanism of change was that people would isolate themselves and so avoid infection, with the primary intended outcome being reduction in mortality in the shielding group. Unintended impacts included negative impact on mental and physical health and well-being. Details of the intervention varied slightly across the home nations of the UK and were subject to minor revisions during the time the intervention was in place. Conclusions: Shielding was a largely untested strategy, aiming to mitigate risk by placing a responsibility on individuals to protect themselves. The model of its rationale, components and outcomes (intended and unintended) will inform evaluation of the impact of shielding and help us to understand its effect and limitations.</abstract><type>Journal Article</type><journal>BMJ Open</journal><volume>13</volume><journalNumber>8</journalNumber><paginationStart>e073464</paginationStart><paginationEnd/><publisher>BMJ</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2044-6055</issnPrint><issnElectronic>2044-6055</issnElectronic><keywords>COVID-19, pandemic, shielding policy, EVITE Immunity evaluation, UK</keywords><publishedDay>30</publishedDay><publishedMonth>8</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-08-30</publishedDate><doi>10.1136/bmjopen-2023-073464</doi><url>http://dx.doi.org/10.1136/bmjopen-2023-073464</url><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>This work is supported by the National Core Studies Immunity Programme (NCSi4P).</funders><projectreference/><lastEdited>2023-09-12T15:22:53.5767900</lastEdited><Created>2023-08-05T09:39:55.2441976</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Alison</firstname><surname>Porter</surname><orcid>0000-0002-3408-7007</orcid><order>1</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>2</order></author><author><firstname>Andrew</firstname><surname>Carson-Stevens</surname><order>3</order></author><author><firstname>Jeremy</firstname><surname>Dale</surname><orcid>0000-0001-9256-3553</orcid><order>4</order></author><author><firstname>Lucy</firstname><surname>Dixon</surname><order>5</order></author><author><firstname>Adrian</firstname><surname>Edwards</surname><orcid>0000-0002-6228-4446</orcid><order>6</order></author><author><firstname>Bridie</firstname><surname>Evans</surname><order>7</order></author><author><firstname>Lesley</firstname><surname>Griffiths</surname><order>8</order></author><author><firstname>Ann</firstname><surname>John</surname><orcid>0000-0002-5657-6995</orcid><order>9</order></author><author><firstname>Stephen</firstname><surname>Jolles</surname><order>10</order></author><author><firstname>Mark</firstname><surname>Kingston</surname><orcid>0000-0003-2242-4210</orcid><order>11</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><orcid>0000-0001-5225-000X</orcid><order>12</order></author><author><firstname>Jennifer</firstname><surname>Morgan</surname><order>13</order></author><author><firstname>Berni</firstname><surname>Sewell</surname><orcid>0000-0001-5471-922X</orcid><order>14</order></author><author><firstname>Anthony</firstname><surname>Whiffen</surname><order>15</order></author><author><firstname>Victoria</firstname><surname>Williams</surname><order>16</order></author><author><firstname>Helen</firstname><surname>Snooks</surname><orcid>0000-0003-0173-8843</orcid><order>17</order></author></authors><documents><document><filename>64039__28509__5b3c64dd865f4357afbdbab729252a25.pdf</filename><originalFilename>64039.VOR.pdf</originalFilename><uploaded>2023-09-12T15:05:16.0624192</uploaded><type>Output</type><contentLength>768007</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>© Author(s) 2023. 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spelling v2 64039 2023-08-05 Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study fcc861ec479a79f7fb9befb13192238b 0000-0002-3408-7007 Alison Porter Alison Porter true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 6098eddc58e31ac2f3e070cb839faa6a Bridie Evans Bridie Evans true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 3442763d6ff0467963e0792d2b5404fa 0000-0003-2242-4210 Mark Kingston Mark Kingston true false 83efcf2a9dfcf8b55586999d3d152ac6 0000-0001-5225-000X Ronan Lyons Ronan Lyons true false f6a4af2cfa4275d2a8ebba292fa14421 0000-0001-5471-922X Berni Sewell Berni Sewell true false 8e349e6cd609923657399f5a64331cb3 Victoria Williams Victoria Williams true false ab23c5e0111b88427a155a1f495861d9 0000-0003-0173-8843 Helen Snooks Helen Snooks true false 2023-08-05 HDAT Introduction: Shielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the first year of the pandemic from March 2020. As the first stage in the EVITE Immunity evaluation (Effects of shielding for vulnerable people during COVID-19 pandemic on health outcomes, costs and immunity, including those with cancer:quasi-experimental evaluation), we generated a logic model to describe the programme theory underlying the shielding intervention. Design and participants: We reviewed published documentation on shielding to develop an initial draft of the logic model. We then discussed this draft during interviews with 13 key stakeholders involved in putting shielding into effect in Wales and England. Interviews were recorded, transcribed and analysed thematically to inform a final draft of the logic model. Results: The shielding intervention was a complex one, introduced at pace by multiple agencies working together. We identified three core components: agreement on clinical criteria; development of the list of people appropriate for shielding; and communication of shielding advice. In addition, there was a support programme, available as required to shielding people, including food parcels, financial support and social support. The predicted mechanism of change was that people would isolate themselves and so avoid infection, with the primary intended outcome being reduction in mortality in the shielding group. Unintended impacts included negative impact on mental and physical health and well-being. Details of the intervention varied slightly across the home nations of the UK and were subject to minor revisions during the time the intervention was in place. Conclusions: Shielding was a largely untested strategy, aiming to mitigate risk by placing a responsibility on individuals to protect themselves. The model of its rationale, components and outcomes (intended and unintended) will inform evaluation of the impact of shielding and help us to understand its effect and limitations. Journal Article BMJ Open 13 8 e073464 BMJ 2044-6055 2044-6055 COVID-19, pandemic, shielding policy, EVITE Immunity evaluation, UK 30 8 2023 2023-08-30 10.1136/bmjopen-2023-073464 http://dx.doi.org/10.1136/bmjopen-2023-073464 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University This work is supported by the National Core Studies Immunity Programme (NCSi4P). 2023-09-12T15:22:53.5767900 2023-08-05T09:39:55.2441976 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Alison Porter 0000-0002-3408-7007 1 Ashley Akbari 0000-0003-0814-0801 2 Andrew Carson-Stevens 3 Jeremy Dale 0000-0001-9256-3553 4 Lucy Dixon 5 Adrian Edwards 0000-0002-6228-4446 6 Bridie Evans 7 Lesley Griffiths 8 Ann John 0000-0002-5657-6995 9 Stephen Jolles 10 Mark Kingston 0000-0003-2242-4210 11 Ronan Lyons 0000-0001-5225-000X 12 Jennifer Morgan 13 Berni Sewell 0000-0001-5471-922X 14 Anthony Whiffen 15 Victoria Williams 16 Helen Snooks 0000-0003-0173-8843 17 64039__28509__5b3c64dd865f4357afbdbab729252a25.pdf 64039.VOR.pdf 2023-09-12T15:05:16.0624192 Output 768007 application/pdf Version of Record true © Author(s) 2023. Distributed under the terms of a Creative Commons Attribution Non Commercial 4.0 License (CC BY-NC 4.0). true eng https://creativecommons.org/licenses/by-nc/4.0/
title Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study
spellingShingle Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study
Alison Porter
Ashley Akbari
Bridie Evans
Ann John
Mark Kingston
Ronan Lyons
Berni Sewell
Victoria Williams
Helen Snooks
title_short Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study
title_full Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study
title_fullStr Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study
title_full_unstemmed Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study
title_sort Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study
author_id_str_mv fcc861ec479a79f7fb9befb13192238b
aa1b025ec0243f708bb5eb0a93d6fb52
6098eddc58e31ac2f3e070cb839faa6a
ed8a9c37bd7b7235b762d941ef18ee55
3442763d6ff0467963e0792d2b5404fa
83efcf2a9dfcf8b55586999d3d152ac6
f6a4af2cfa4275d2a8ebba292fa14421
8e349e6cd609923657399f5a64331cb3
ab23c5e0111b88427a155a1f495861d9
author_id_fullname_str_mv fcc861ec479a79f7fb9befb13192238b_***_Alison Porter
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
6098eddc58e31ac2f3e070cb839faa6a_***_Bridie Evans
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
3442763d6ff0467963e0792d2b5404fa_***_Mark Kingston
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
f6a4af2cfa4275d2a8ebba292fa14421_***_Berni Sewell
8e349e6cd609923657399f5a64331cb3_***_Victoria Williams
ab23c5e0111b88427a155a1f495861d9_***_Helen Snooks
author Alison Porter
Ashley Akbari
Bridie Evans
Ann John
Mark Kingston
Ronan Lyons
Berni Sewell
Victoria Williams
Helen Snooks
author2 Alison Porter
Ashley Akbari
Andrew Carson-Stevens
Jeremy Dale
Lucy Dixon
Adrian Edwards
Bridie Evans
Lesley Griffiths
Ann John
Stephen Jolles
Mark Kingston
Ronan Lyons
Jennifer Morgan
Berni Sewell
Anthony Whiffen
Victoria Williams
Helen Snooks
format Journal article
container_title BMJ Open
container_volume 13
container_issue 8
container_start_page e073464
publishDate 2023
institution Swansea University
issn 2044-6055
2044-6055
doi_str_mv 10.1136/bmjopen-2023-073464
publisher BMJ
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
url http://dx.doi.org/10.1136/bmjopen-2023-073464
document_store_str 1
active_str 0
description Introduction: Shielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the first year of the pandemic from March 2020. As the first stage in the EVITE Immunity evaluation (Effects of shielding for vulnerable people during COVID-19 pandemic on health outcomes, costs and immunity, including those with cancer:quasi-experimental evaluation), we generated a logic model to describe the programme theory underlying the shielding intervention. Design and participants: We reviewed published documentation on shielding to develop an initial draft of the logic model. We then discussed this draft during interviews with 13 key stakeholders involved in putting shielding into effect in Wales and England. Interviews were recorded, transcribed and analysed thematically to inform a final draft of the logic model. Results: The shielding intervention was a complex one, introduced at pace by multiple agencies working together. We identified three core components: agreement on clinical criteria; development of the list of people appropriate for shielding; and communication of shielding advice. In addition, there was a support programme, available as required to shielding people, including food parcels, financial support and social support. The predicted mechanism of change was that people would isolate themselves and so avoid infection, with the primary intended outcome being reduction in mortality in the shielding group. Unintended impacts included negative impact on mental and physical health and well-being. Details of the intervention varied slightly across the home nations of the UK and were subject to minor revisions during the time the intervention was in place. Conclusions: Shielding was a largely untested strategy, aiming to mitigate risk by placing a responsibility on individuals to protect themselves. The model of its rationale, components and outcomes (intended and unintended) will inform evaluation of the impact of shielding and help us to understand its effect and limitations.
published_date 2023-08-30T15:22:55Z
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