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首页> 外文期刊>JMIR public health and surveillance. >Determinants of Shielding Behavior During the COVID-19 Pandemic and Associations With Well-being Among National Health Service Patients: Longitudinal Observational Study
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Determinants of Shielding Behavior During the COVID-19 Pandemic and Associations With Well-being Among National Health Service Patients: Longitudinal Observational Study

机译：Covid-19大流行和与国家卫生服务患者福祉协会期间屏蔽行为的决定因素：纵向观察研究

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Background The UK National Health Service (NHS) classified 2.2 million people as clinically extremely vulnerable (CEV) during the first wave of the 2020 COVID-19 pandemic, advising them to “shield” (to not leave home for any reason). Objective The aim of this study was to measure the determinants of shielding behavior and associations with well-being in a large NHS patient population for informing future health policy. Methods Patients contributing to an ongoing longitudinal participatory epidemiology study (Longitudinal Effects on Wellbeing of the COVID-19 Pandemic [LoC-19], n=42,924) received weekly email invitations to complete questionnaires (17-week shielding period starting April 9, 2020) within their NHS personal electronic health record. Question items focused on well-being. Participants were stratified into four groups by self-reported CEV status (qualifying condition) and adoption of shielding behavior (baselined at week 1 or 2). The distribution of CEV criteria was reported alongside situational variables and univariable and multivariable logistic regression. Longitudinal trends in physical and mental well-being were displayed graphically. Free-text responses reporting variables impacting well-being were semiquantified using natural language processing. In the lead up to a second national lockdown (October 23, 2020), a follow-up questionnaire evaluated subjective concern if further shielding was advised. Results The study included 7240 participants. In the CEV group (n=2391), 1133 (47.3%) assumed shielding behavior at baseline, compared with 633 (13.0%) in the non-CEV group (n=4849). CEV participants who shielded were more likely to be Asian (odds ratio [OR] 2.02, 95% CI 1.49-2.76), female (OR 1.24, 95% CI 1.05-1.45), older (OR per year increase 1.01, 95% CI 1.00-1.02), living in a home with an outdoor space (OR 1.34, 95% CI 1.06-1.70) or three to four other inhabitants (three: OR 1.49, 95% CI 1.15-1.94; four: OR 1.49, 95% CI 1.10-2.01), or solid organ transplant recipients (OR 2.85, 95% CI 2.18-3.77), or have severe chronic lung disease (OR 1.63, 95% CI 1.30-2.04). Receipt of a government letter advising shielding was reported in 1115 (46.6%) CEV participants and 180 (3.7%) non-CEV participants, and was associated with adopting shielding behavior (OR 3.34, 95% CI 2.82-3.95 and OR 2.88, 95% CI 2.04-3.99, respectively). In CEV participants, shielding at baseline was associated with a lower rating of mental well-being and physical well-being. Similar results were found for non-CEV participants. Concern for well-being if future shielding was required was most prevalent among CEV participants who had originally shielded. Conclusions Future health policy must balance the potential protection from COVID-19 against our findings that shielding negatively impacted well-being and was adopted in many in whom it was not indicated and variably in whom it was indicated. This therefore also requires clearer public health messaging and support for well-being if shielding is to be advised in future pandemic scenarios.
机译：背景技术英国国家卫生服务（NHS）在2020年Covid-19大流行的第一波浪潮中归类为临床极度脆弱的（CEV），建议他们“盾牌”（不出于任何原因离开家）。客观本研究的目的是衡量屏蔽行为和协会的决定因素，以良好的患者患者患者提供信息，以告知未来的卫生政策。方法对持续纵向参与性流行病学研究的患者（Covid-19大流行[LOC-19]，N = 42,924）的持续纵向参与性流行病学研究（纵向效应，N = 42,924）收到了每周电子邮件邀请，以完成问卷（从4月9日开始的17周屏蔽期）在他们的NHS个人电子健康记录中。问题项目集中在福祉上。通过自我报告的CEV地位（资格化条件）和采用屏蔽行为（第1周或第2周基础），参与者分为四组。 CEV标准的分布伴随着局势变量和单变量和多变量的逻辑回归。以图形方式显示身体和心理幸福的纵向趋势。自由文本响应报告变量影响福祉的变量是使用自然语言处理的半定义。在领先于第二届国家锁定（10月23日），如果建议进一步屏蔽，则会评估主观关注的后续调查问卷。结果该研究包括7240名参与者。在CEV组（n = 2391）中，1133（47.3％）在基线上假设屏蔽行为，而非CEV组中的633（13.0％）（n = 4849）。屏蔽的CEV参与者更有可能是亚洲（赔率比[或] 2.02,95％CI 1.49-2.76），女性（或1.24,95％CI 1.05-1.45），年龄较大（或每年增加1.01，95％CI 1.00-1.02），生活在室外空间（或1.34,95％CI 1.06-1.70）或三到四个其他居民（三个：或1.49,95％CI 1.15-1.94;四：或1.49，95％ CI 1.10-2.01）或固体器官移植受者（或2.85,95％CI 2.18-3.77），或具有严重的慢性肺病（或1.63,95％CI 1.30-2.04）。 1115（46.6％）CEV参与者和180名（3.7％）非CEV参与者报告了政府信咨询了屏蔽，并与采用屏蔽行为（或3.34,95％CI 2.82-3.95和或2.88,95相关​​联％CI 2.04-3.99）分别）。在CEV参与者中，基线屏蔽与精神福祉和身体健康的较低评级有关。为非CEV参与者找到了类似的结果。如果需要未来的屏蔽，则对最初屏蔽的CEV参与者中需要普遍存在的幸福感。结论未来的卫生政策必须平衡Covid-19的潜在保护，以防止我们的调查结果屏蔽受对受影响的福祉，并且在许多人中被采用，其中许多人未被表明和可变地指出。因此，如果要在未来的大流行情景中建议屏蔽，这也需要更清晰的公共卫生消息传递和支持福祉。

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