Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study
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 pa...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/8/e073464.full |
| _version_ | 1797754405375705088 |
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| author | Stephen Jolles Ashley Akbari Andrew Carson-Stevens Helen Snooks Adrian Edwards Bridie Evans Ann John Alison Porter Jeremy Dale Ronan Lyons Jennifer Morgan Bernadette Sewell Mark Rhys Kingston Lesley Griffiths Lucy Dixon Anthony Whiffen Victoria Angharad Williams |
| author_facet | Stephen Jolles Ashley Akbari Andrew Carson-Stevens Helen Snooks Adrian Edwards Bridie Evans Ann John Alison Porter Jeremy Dale Ronan Lyons Jennifer Morgan Bernadette Sewell Mark Rhys Kingston Lesley Griffiths Lucy Dixon Anthony Whiffen Victoria Angharad Williams |
| author_sort | Stephen Jolles |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-12T17:32:03Z |
| format | Article |
| id | doaj.art-e1979f9e91bb4a889036930b7c1804dc |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-12T17:32:03Z |
| publishDate | 2023-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-e1979f9e91bb4a889036930b7c1804dc2023-08-04T17:40:07ZengBMJ Publishing GroupBMJ Open2044-60552023-08-0113810.1136/bmjopen-2023-073464Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative studyStephen Jolles0Ashley Akbari1Andrew Carson-Stevens2Helen Snooks3Adrian Edwards4Bridie Evans5Ann John6Alison Porter7Jeremy Dale8Ronan Lyons9Jennifer Morgan10Bernadette Sewell11Mark Rhys Kingston12Lesley Griffiths13Lucy Dixon14Anthony Whiffen15Victoria Angharad Williams16School of Medicine, Cardiff University, Cardiff, UKSwansea University Medical School, Swansea University, Swansea, UKDivision of Population Medicine, Cardiff University, Cardiff, UK2 Swansea University Medical School, Swansea University, Swansea, UKWales Centre for Primary and Emergency Care Research, Cardiff University, Cardiff, UK1Swansea University, UKSwansea University Medical School, Swansea, UK2 Swansea University Medical School, Swansea University, Swansea, UKWarwick Medical School, University of Warwick, Coventry, UKSwansea University Medical School, Swansea University, Swansea, UK5Public Health – Seattle and King County, Seattle, USASwansea Centre for Health Economics, Swansea University, Swansea, Wales, UKSwansea University Medical School, Swansea, UK3Patient and Public Involvement, UKSwansea University Medical School, Swansea, UKAdministrative Data Research Unit, Welsh Government, Cardiff, UKSwansea University Medical School, Swansea University, Swansea, UKIntroduction 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.https://bmjopen.bmj.com/content/13/8/e073464.full |
| spellingShingle | Stephen Jolles Ashley Akbari Andrew Carson-Stevens Helen Snooks Adrian Edwards Bridie Evans Ann John Alison Porter Jeremy Dale Ronan Lyons Jennifer Morgan Bernadette Sewell Mark Rhys Kingston Lesley Griffiths Lucy Dixon Anthony Whiffen Victoria Angharad Williams Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study BMJ Open |
| title | 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_short | 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 |
| url | https://bmjopen.bmj.com/content/13/8/e073464.full |
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