Factors Associated with the Implementation of Non-Pharmaceutical Interventions for Reducing Coronavirus Disease 2019 (COVID-19): A Systematic Review
Abstract
:1. Introduction
Research Question (RQ)
2. Materials and Methods
2.1. Criteria for Considering Studies for the Study
- Types of participants: all studies that involve human subjects of any age or gender, including ethnic (Black, Asian, White) and healthcare worker (medical doctors, nurses, allied healthcare professions) groups.
- Types of intervention: research describing three major NPIs, e.g., social distance, isolation and quarantine, focusing only on COVID-19/SARS-CoV-2.
- Types of outcome measure: primary outcomes include: COVID-19; reducing the risk of transmission/infection of COVID-19; secondary outcomes include changes in social behaviour, for example, SD by avoiding crowds, restricting movements, isolating ill patients and quarantine of exposed people.
- Types of studies: no study design filter is added. To measure the impact of NPIs, this review considered all studies evaluating the effectiveness of NPIs relating to reducing the risk of transmission/infection of COVID-19. We included both RCTs and non-RCTs, for example, cross-sectional, survey, case-control, RCTs and observational studies (retrospective or prospective) including preprint engines such as medRxiv, bioRxiv, Litcovid and SSRN for unpublished studies on COVID-19, given the lags in publication.
- Study period: December 2019 to March 2021.
- Articles published in narrative review, modelling studies, opinions, letters, news, editorials, perspectives, commentaries and any other publications lacking primary data, including grey literature.
- Studies containing duplicate datasets.
2.2. Search Strategy
2.3. Selection of Studies
2.4. Data Extraction, Analysis and Synthesis
2.5. Quality Appraisal (Risk of Bias)
3. Results
3.1. Study Characteristics
3.2. Risk of Bias
3.3. Synthesis of Results
- Theme 1. Positive impact of SD measures.
- Theme 2. Effective public health interventions.
- Theme 3. Positive changes in people’s behaviour.
- Theme 4. Fears and concerns about COVID-19.
- Theme 5. Debatable role of mass media.
- Theme 6. Physical and psychological impacts.
- Theme 7. Ethnicity, age and COVID-19 pandemic.
3.4. Enablers
3.4.1. Theme 1. Positive Impact of SD Measures
- Without strengthening SDMs, local infections are likely to continue occurring, given that the effective reproduction number (R0) is approximately 1 or slightly higher. Travel measures and testing, tracing, and treating efforts are particularly important in maintaining suppression, although these measures will be increasingly difficult to implement as case numbers increase [66].
3.4.2. Theme 2. Effective Public Health Interventions
- The package of public health interventions (including border entry restrictions, quarantine and isolation of cases and contacts, and population behaviour changes, such as social distancing and personal protective measures) that Hong Kong has implemented since late January 2020, is associated with reduced spread of COVID-19 [66].
- The study participants reported frequent use of sanitisers, hand wash, and masks during the past week. This indicates participants’ increasing concern towards personal hygienic measures. Awareness about COVID-19 is reflected in behaviour and attitude as most participants agreed with social distancing, avoiding travel, self-quarantine and adequate hygiene [68].
3.4.3. Theme 3. Positive Changes in People’s Behaviour
- Social distancing and population behavioural changes with social and economic impacts less disruptive than total lockdown can meaningfully control COVID-19. Control measures and changes in population behaviour coincided with a substantial reduction in influenza transmission in early February 2020. This observation suggests the same measures would also have affected COVID-19 transmission in the community, because of some similarities, as well as differences, in the modes of transmission of influenza and COVID-19 [66].
- Avoiding close contact, washing hands and wearing facial masks were considered the most protective measures [77].
- Hand hygiene is a major element in the prevention of COVID-19 and other infectious disease [90].
3.5. Barriers
3.5.1. Theme 4. Fears and Concerns about COVID-19
- Overall, 77.4% (1640/2108) of respondents reported being worried about COVID-19 in the UK. For those not previously testing positive for COVID-19, 47.5% (979/2108) believed it was likely they would be infected at some point in the future under the UK Government’s preventive measures. If infected, just over half (56.9%) would expect to be moderately/severely affected (e.g., may need self-care and rest in bed) [65].
- People are very worried and are not willing to go to health facilities even if they have general problems. They used to contact health personnel through phone calls, but they were not willing to visit any health centres due to fear of getting COVID-19 from health workers. Fear of transmission was pervasive among health workers as well [90].
- The analysis of contact characteristics showed that the incidence rate of close contacts who lived in the same residence was 17.9%, significantly higher than those of other groups with different forms of contact. The incidence rate of relatives was 10.7%, with the highest risk of infection among all relationship groups. The results showed that the closer the contact distance and the higher the frequency of contact, the greater the risk of infection [72].
- Most participants felt that guidance on social distancing and isolation had been generally unclear, although some described how it had “become clearer”. Many participants exhibited lack of trust in government or in the media [88].
- One study has highlighted the implication of health systems:
- The weak infrastructure, under-resourced health system, widespread of the illiteracy and social practices will negatively influence the spread of the COVID-19 and response towards its prevention [89].
3.5.2. Theme 5. Debatable Role of Mass Media
- Approximately 28% of people report sleep difficulties. More than two-thirds of participants reported themselves worried after seeing posts about COVID-19 on social media [69].
- Approximately 46% of participants reported worry regarding discussion of COVID-19 in news channels and print media. This indicates a significant proportion of survey participants, despite having adequate awareness about coronavirus infection, are largely influenced by media information. Media influences mental wellbeing and adds to anxiety levels [69].
3.5.3. Theme 6. Physical and Psychological Impacts
- The mandated lack of social and, especially, physical contact with family members were identified as particularly difficult. Confinement at home and work, being unable to see friends, being unable to shop for basic necessities of everyday life, and being unable to purchase thermometers and prescribed medications enhanced their feeling of distance from the outside world [71].
- All participants felt that the social distancing and isolation policies had had significant social and psychological impacts on their lives and the central theme was loss […]. These emotional and psychological losses were particularly acute for those living in more urban, densely populated cities like London or Birmingham. They were also especially evident amongst those in low-paid or precarious occupations, who had either lost their job or income or were now relying on parental, familial or state financial support as a result of the pandemic [88].
- During the COVID-19 pandemic parents emerged with various type of emotional problems, to the extent that some parents experienced symptoms of anxiety (6.6%) and depression (21.7%) which included washing their hands frequently and findings themselves preoccupied with physical discomfort [91].
3.5.4. Theme 7. Ethnicity, Age and COVID-19 Pandemic
- More disadvantaged backgrounds were less likely to be able to work from home or self-isolate if needed, suggesting structural barriers to adopting preventive behaviours in these groups. The most economically disadvantaged in society are less able to comply with certain NPIs, likely partly due to their financial situation [65].
4. Discussion
Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Search Terms | Search Date | Reviewers |
---|---|---|
#1: “COVID 19”(MeSH Terms) OR “COVID 19”(All Fields) OR “sars cov 2”(All Fields) OR “sars cov 2”(MeSH Terms) OR “severe acute respiratory syndrome coronavirus 2”(All Fields) OR “ncov”(All Fields) OR “2019 ncov”(All Fields) OR “coronavirus infections”(MeSH Terms) OR “coronavirus”(MeSH Terms) OR “coronavirus”(All Fields) OR “coronaviruses”(All Fields) OR “betacoronavirus”(MeSH Terms) OR “betacoronavirus”(All Fields) OR “betacoronaviruses”(All Fields) OR “wuhan coronavirus”(All Fields) | 12 March 2021 | K.R., C.M.L. |
#2: “social distance”(All Fields) OR “social distancing”(All Fields) OR “cohorting”(All Fields) OR “community containment”(All Fields) OR “isolation strategy”(All Fields) OR “isolation”(All Fields) OR “patient isolation”(All Fields) OR “patient isolation”(MeSH Terms) OR “patient isolators”(All Fields) OR “patient isolators”(MeSH Terms) OR “physical contact”(All Fields) OR “physical distancing”(All Fields) OR “quarantine”(All Fields) OR “quarantines”(All Fields) OR “quarantine”(MeSH Terms) OR OR “quarantined”(All Fields) OR “quarantining”(All Fields) OR “Banning”(All Fields) OR “distancing”(All Fields) | ||
#3: “reduce”(All Fields) OR “reduced”(All Fields) OR “reduces”(All Fields) OR “reducing”(All Fields) OR “transmission”(MeSH Subheading) OR “transmission”(All Fields) OR “transmissions”(All Fields) OR “prevention and control”(MeSH Subheading) OR “prevention and control”(All Fields) OR “prevention”(All Fields) OR “reduce infection”(All Fields) | ||
#4: #1 AND #2 AND #3 |
Study ID | Aims/Study Question | Country | Type of Study | Samples | JBI Appraisal Tools * | Reviewer Comments | ||||
---|---|---|---|---|---|---|---|---|---|---|
Number of Questioned Answered | JBI | |||||||||
Yes | No | Unclear | NA | |||||||
Atchison et al. [65] | To examine risk perceptions and behavioural responses of the UK adult population during the early phase of the COVID-19 epidemic. | UK | Cross-sectional survey | 2108 | 1, 2, 4, 7, 8 | 3, 5, 8 | 0 | 0 | Quant. 5/8 | Lack of methodological details but plausible analysis. |
Cowling et al. [66] | To examine the effect of these interventions and behavioural changes of the public on the incidence of COVID-19, as well as on influenza virus infections, which might share some aspects of transmission dynamics with COVID-19. | Hong Kong | Cross-sectional telephone survey | 3013 | 1, 2, 4, 7, 8 | 3, 5, 6 | 0 | 0 | Quant. 5/8 | Lack of methodological details but plausible analysis. |
Pan et al. [67] | To evaluate the association of public health interventions with the epidemiological features of the COVID-19 outbreak in Wuhan by 5 periods according to key events and interventions. | China | Quantitative survey | 32,583 | 2, 4, 7, 8 | 1, 3, 5, 6 | 0 | 0 | Quant. 4/8 | Poor methodological details. |
Rios-González [68] | To examine the knowledge, attitudes and practices of the population about COVID-19. | Paraguay | Cross-sectional study | 3141 | 2, 3, 7, 8 | 1, 4, 5, 6 | 0 | 0 | Quant. 4/8 | Poor methodological details. |
Roy et al. [69] | To assess the knowledge, attitude, anxiety experience, and perceived mental healthcare need among the adult Indian population during the COVID-19 pandemic. | India | Cross-sectional, observational study | 662 | 1, 2, 7, 8 | 3, 4, 5, 6 | 0 | 0 | Quant. 4/8 | Poor methodological details. |
Al-Hanawi et al. [70] | To investigate COVID-19 knowledge, attitudes and practices (KAP), and associated sociodemographic characteristics among the general population. | Saudi Arabia | Cross-sectional study | 3388 | 1, 2, 3, 4, 6, 7, 8 | 5 | 0 | 0 | Quant. 7/8 | Few gaps in methodological details but plausible analysis. |
Liu et al. [71] | To examine the protective effects of appropriate personal protective equipment for frontline healthcare professionals who provided care for patients with coronavirus disease 2019 (COVID-19). | China | Cross-sectional study | 420 | 1, 2, 3, 4, 6, 7, 8 | 5 | 0 | 0 | Quant. 7/8 | Few gaps in methodological details but plausible analysis. |
Wu et al. [72] | To determine the rate of secondary infection among contacts of individuals with confirmed COVID-19 in Hangzhou according to the type of contact, the intensity of the contact, and their relationship with the index patient. | China | Retrospective cohort study | 2994 | 1, 2, 3, 6, 7, 11 | 4, 5, 8, 9, 10 | 0 | 0 | Cohor.7/11 | Some gaps in the methodology. |
Alobuia et al. [73] | To determine whether disparities exist in the levels of knowledge, attitudes and practices (KAPs) related to COVID-19. | USA | Cross-sectional study | 1216 | 1, 2, 4, 8 | 3, 5, 6, 7 | 0 | 0 | Quant. 4/8 | Poor methodological details; some gaps in the methodology. |
Feng et al. [74] | To explore the influence of altruism on negative affect and mental health (anxiety and depressive symptoms) during the COVID-19 pandemic while people self-isolated at home in China. | China | Cross-sectional study | 1346 | 1, 2, 4, 7, 8 | 3, 5, 6 | 0 | 0 | Quant. 5/8 | Some gaps in methodology but overall convincing. |
Shorey et al. [75] | To analyse the comments left on local media news outlets to find common concerns and discuss potential new measures that can be developed to reduce panic and support for Singapore’s public during and beyond COVID-19. | Singapore | Qualitative study | Not provided (NP) | 3, 4, 5, 8, 9, 10 | 1, 2, 6, 7 | 0 | 0 | Quali. 6/10 | Some gaps in methodology. |
Sikkema et al. [76] | To understand sources and modes of transmission of SARS-CoV-2 in healthcare workers and patients. | Netherlands | Cross-sectional study | 96 | 1, 2, 3, 4, 7 | 5, 6, 8 | 0 | 0 | Quant. 5/8 | Some gaps in methodology but overall convincing. |
Rugarabamu et al. [77] | To investigate KAP towards COVID-19 KAP among residents in Tanzania during the April–May 2020 period of the epidemic. | Tanzania | Cross-sectional study | 400 | 2, 4, 7, 8 | 1, 3, 5, 6 | 0 | 0 | Quant. 4/8 | Some gaps in the methodology. |
Grannell et al. [78] | To examine the impact of the pandemic on their lived experience from a treatment and psychosocial standpoint and additionally explore their awareness of obesity as a risk factor for COVID-19 disease severity. | Ireland | Qualitative study | 23 | 1, 2, 3, 4, 5, 8, 9, 10 | 6, 7 | 0 | 0 | Quali. 8/10 | Some gaps in methodology but overall convincing. |
Moorthy and Sankar [79] | To explore the beliefs and perception about the reported worrying issue among the BAME health workforce in the diverse city of Leicester. | UK | Cross-sectional study | 200 | 1, 2, 3, 4, 5, 7, 8 | 6 | 0 | 0 | Quant. 7/8 | Some gaps in methodological details but plausible analysis. |
Solerte et al. [80] | To report several clinical and biochemical outcomes in patients with type 2 diabetes hospitalized for COVID-19. | Italy | Case-control, retrospective study | 338 | 1, 2, 3, 4, 5, 8, 10 | 6, 7, 9 | 0 | 0 | Case-Contr. 7/10 | Appropriate methodological details and plausible analysis. |
Vally [81] | To examine the public’s perceptions of the pandemic, assesses the extent to which participants have adhered to a range of recommended health-protective behaviours to prevent infection and evaluates whether anxiety about COVID-19 or perceptions related to the pandemic are associated with greater adherence to these behaviours. | United Arab Emirates, Abu Dhabi and Dubai | Cross-sectional study | 634 | 1, 2, 3, 4, 7, 8 | 5, 6 | 0 | 0 | Quant. 6/8 | Some gaps in methodological details but plausible analysis. |
Smith et al. [82] | To investigate factors associated with adherence to self-isolation and lockdown measures due to COVID-19 in the UK. | UK | Cross-sectional survey | 217 | 1, 2, 3, 4, 6, 7, 8 | 5 | 0 | 0 | Quant. 7/8 | Appropriate methodological details and plausible analysis. |
Jing et al. [83] | To estimate the secondary attack rate of SARS-CoV-2 among household and non-household close contacts in Guangzhou, China. | China | Retrospective cohort study | 349 | 1, 2, 3, 6, 7, 11 | 4, 5, 8, 9, 10 | 0 | 0 | Cohort. 6/11 | Some gaps in methodological details but plausible analysis. |
Islam et al. [84] | To investigate the KAP toward COVID-19 among slum dwellers resided in Dhaka City, Bangladesh. | Bangladesh | Cross-sectional study | 406 | 1, 2, 3, 4, 7, 8 | 5, 6 | 0 | 0 | Quant. 6/8 | Some gaps in methodological details but plausible analysis. |
Makhashvili et al. [85] | To examine concern about COVID-19 and its association with symptoms of mental disorders in the Republic of Georgia. | Georgia | Cross-sectional study | 2088 | 1, 2, 3, 4, 6, 7, 8 | 5 | 0 | 0 | Quant. 7/8 | Appropriate methodological details and plausible analysis. |
Bäuerle et al. [86] | To assess initial data on the mental health burden of the German public during the COVID-19 pandemic. | Germany | Cross-sectional study | 15,037 | 1, 2, 3, 4, 7, 8 | 5, 6 | 0 | 0 | Quant. 6/8 | Some gaps in methodology but overall convincing. |
Skoda et al. [87] | To close the research gap and provide initial findings on the psychological burden of German healthcare professionals after the COVID-19 outbreak. | Germany | Cross-sectional study | 12,863 | 1, 2, 3, 7, 8 | 4, 5, 6 | 0 | 0 | Quant. 5/8 | Poor methodological details; some gaps in the methodologies but overall convincing. |
Williams et al. [88] | To explore the perceptions and experiences of the UK public of social distancing and social isolation measures related to the COVID-19 pandemic. | UK | Qualitative—focus group study | 27 | 1, 2, 3, 4, 5, 8, 9, 10 | 6, 7 | 0 | 0 | Quali. 8/10 | Some gaps in methodology but overall convincing. |
Mohamed et al. [89] | To assess the knowledge, attitude, and practices of the Sudanese population towards COVID-19. | Sudan | Descriptive cross-sectional | 987 | 1, 2, 3, 4, 7, 8 | 5, 6 | 0 | 0 | Quant. 6/8 | Some gaps in methodology but overall convincing. |
Singh et al. [90] | To explore community perceptions of COVID-19 and their experiences towards health services utilization during the pandemic in Province-2 of Nepal. | Nepal | Qualitative study | 41 | 2, 3, 4, 5, 6, 8, 9, 10 | 1, 7 | 0 | 0 | Quali. 8/10 | Few gaps in methodological details but plausible analysis. |
Wang et al. [91] | To investigate psychological distress among parents of children with ASD during the COVID-19 pandemic. | China | Cross-sectional study | 6726 | 1, 2, 3, 4, 7, 8 | 5, 6 | 0 | 0 | Quant. 6/8 | Some gaps in methodology but overall convincing. |
Wolf et al. [92] | To determine COVID-19 awareness, knowledge, attitudes, and related behaviours among U.S. adults who are more vulnerable to complications of infection because of age and comorbid conditions. | USA | Cross-sectional survey | 630 | 1, 2, 3, 4, 7, 8 | 5, 6 | 0 | 0 | Quant. 6/8 | Few gaps in methodological details but plausible analysis. |
Zhong et al. [93] | To investigate Chinese residents’ KAP towards COVID-19 during the rapid rise period of the outbreak. | China | Cross-sectional survey | 6919 | 1, 2, 3, 4, 7, 8 | 5.6 | 0 | 0 | Quant. 6/8 | Some gaps in methodology but overall convincing. |
Gallè et al. [94] | To (i) evaluate the level of knowledge about the 2019-nCoV, it’s spread and the control measures adopted; (ii) analyse health-related behaviours during lockdown, in order to estimate its possible impact on personal habits; (iii) understand if the study field may influence the level of knowledge and lifestyle habits during the pandemic. | Italy | Quantitative survey | 2125 | 1, 3, 7, 8 | 2, 4, 5, 6 | 0 | 0 | Quant. 4/8 | Poor methodological details. |
Geldsetzer [95] | To assess knowledge and perceptions about COVID-19 among a convenience sample of the general public in the United States and the United Kingdom. | UK and USA | Cross-sectional survey | 5974 | 2, 3, 4, 7, 8 | 1, 5, 6 | 0 | 0 | Quant. 5/8 | Poor methodological details. |
Katz et al. [96] | To identify key features of preparedness and the primary concerns of local public health officials in deciding to implement social distancing measures, and determine whether any particular factor could explain the widespread variation among health departments in responses to past outbreaks. | USA | Cross-sectional online survey | 150 | 1, 2, 4, 7, 8 | 3, 5, 6 | 0 | 0 | Quant. 5/8 | Lack of methodological details but plausible analysis. |
Meier et al. [97] | To evaluate public belief in the effectiveness of protective measures, to what extent individuals have implemented these measures in their daily lives, and to identify key communication channels used to acquire information on COVID-19 in European countries. | Netherlands, Germany and Italy | Cross-sectional survey study | 9796 | 1, 2, 3, 4, 7, 8 | 5, 6 | 0 | 0 | Quant. 6/8 | Some gaps in methodological details but plausible analysis. |
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Regmi, K.; Lwin, C.M. Factors Associated with the Implementation of Non-Pharmaceutical Interventions for Reducing Coronavirus Disease 2019 (COVID-19): A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 4274. https://doi.org/10.3390/ijerph18084274
Regmi K, Lwin CM. Factors Associated with the Implementation of Non-Pharmaceutical Interventions for Reducing Coronavirus Disease 2019 (COVID-19): A Systematic Review. International Journal of Environmental Research and Public Health. 2021; 18(8):4274. https://doi.org/10.3390/ijerph18084274
Chicago/Turabian StyleRegmi, Krishna, and Cho Mar Lwin. 2021. "Factors Associated with the Implementation of Non-Pharmaceutical Interventions for Reducing Coronavirus Disease 2019 (COVID-19): A Systematic Review" International Journal of Environmental Research and Public Health 18, no. 8: 4274. https://doi.org/10.3390/ijerph18084274