About the Author(s)


Nuria S. Nwachuku Email symbol
Department of Public Health, Faculty of Allied Medical Sciences, University of Calabar, Calabar, Nigeria

Dachi I. Arikpo symbol
Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria

Ugo J. Agbor symbol
Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria

Peter N. Onyenemerem symbol
Johns Hopkins Program for International Education in Gynecology and Obstetrics (Jhpiego), Uyo, Nigeria

Eleanor A. Ochodo symbol
Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya

Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Helen Smith symbol
International Health Consulting Services Ltd, Merseyside, United Kingdom

Martin Meremikwu symbol
Department of Pediatrics, University of Calabar, Calabar, Nigeria

Citation


Nwachuku NS, Arikpo DI, Agbor UJ, et al. Factors influencing uptake of diagnostic test interventions for SARS-CoV-2: A qualitative review. J Public Health Africa. 2025;16(2), a619. https://doi.org/10.4102/jphia.v16i2.619

Note: The manuscript is a contribution to the themed collection titled ‘Systematic Reviews on Infection Prevention and Control in the context of COVID-19’, under the expert guidance of guest editor Prof. Ehimario Igumbor.

Additional supporting information may be found in the online version of this article as Online Appendix 1 and Online Appendix 2.

Review Article

Factors influencing uptake of diagnostic test interventions for SARS-CoV-2: A qualitative review

Nuria S. Nwachuku, Dachi I. Arikpo, Ugo J. Agbor, Peter N. Onyenemerem, Eleanor A. Ochodo, Helen Smith, Martin Meremikwu

Received: 14 May 2024; Accepted: 13 Jan. 2025; Published: 28 Apr. 2025

Copyright: © 2025. The Author(s). Licensee: AOSIS.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Diagnostic tests for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may be performed based on symptomatic presentation or for screening of asymptomatic persons. Testing can limit spread by enabling rapid identification of cases leading to containment measures. However, views regarding diagnostic test as a containment intervention vary across different settings.

Aim: To synthesise the findings of qualitative studies on the perceptions and factors influencing the uptake of diagnostic test interventions for SARS-CoV-2.

Setting: Healthcare facilities, care homes, communities including households.

Method: We searched MEDLINE database and the (WHO) SARS-CoV-2 Research database from 01 January 2020 to 06 September 2022. Qualitative data were synthesised thematically while data for barriers and facilitators were synthesised using the SURE framework. The GRADE-CERQual approach was used to assess the confidence in each review finding, while the ENTREQ checklist was used to report the QES. The quality of included studies was assessed with the CASP tool.

Results: Twenty two studies were included for QES. Two were conducted in the health facility setting, 2 in care homes, and 18 in the community. Twenty of the studies came from high-income countries, 2 from low- and middle-income countries. In all, 13 analytical and 31 descriptive themes of low to moderate quality evidence emerged; mainly around fear of contracting COVID-19, test procedure and socio-economic implications of a positive test result.

Conclusion: Low to moderate quality evidence of barriers to uptake of diagnostic test were largely due to misconceptions about the interventions.

Contribution: Sensitising and engaging communities and stakeholders in the healthcare system, will help mitigate the fear barrier and enhance policy coordination.

Keywords: infection prevention; diagnostic test; screening; asymptomatic; COVID-19.

Introduction

A variety of infection prevention and control (IPC) strategies were adopted in response to the global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, including use of personal protective equipment (PPE), face masks, physical distancing, proper hand hygiene, respiratory etiquette, cleaning and disinfection, proper ventilation as well as early identification of cases through testing and subsequent isolation.1,2,3,4,5 Diagnostic tests for coronavirus disease 2019 (COVID-19) help to limit spread and enable rapid identification of cases so that appropriate containment measures can be implemented, such as isolation.6,7,8,9,10 Furthermore, testing is essential in assessing epidemiological situations globally and is also required to drive the controlled resumption of social and economic activities globally.11,12,13

Affordability, availability and access to these diagnostic tests could pose a challenge especially in resource constrained settings and will likely influence uptake of these interventions aimed at containing the spread of the disease.14,15,16 Successfully preventing or managing outbreaks through diagnostic tests depends on multiple factors that may act as barriers or facilitators to uptake; these factors cut across the individual, family, community as well as at the organisational levels.17,18,19,20 Availability, acceptability, accessibility, affordability are key issues that drive the success of the diagnostic test strategy.21,22,23,24

Different stakeholders and clients may have varying views and perceptions of diagnostic tests, based on the context in which they live and work.25,26 Furthermore, in some settings where these tests are available, accessible and affordable, uptake have been less than adequate prompting questions on barriers to uptake.23 Therefore, it is important to have an in-depth understanding of contextual factors through qualitative research that may hinder uptake of diagnostic tests across different settings, especially with the advent of rapid diagnostic tests (RDTs), which are easy to operate and available right at the point of care. Identifying positive individuals through diagnostic tests will help reduce the risk of severe illness and risk of long-term disability or death for those infected and reduce the spread of the virus.10 To the best of our knowledge, this is the first qualitative systematic review on perceptions and factors influencing uptake of diagnostic test interventions for IPC in the context of COVID-19.

Aim

The aim of this review is to identify and synthesise the findings of qualitative studies on the perceptions, experiences and views of healthcare providers, recipients of care and community members on diagnostic test interventions and on barriers and facilitators to uptake of diagnostic test interventions in the context of COVID-19. This synthesis was conducted as part of a routine update of the World Health Organization (WHO) guidelines on IPC in the context of COVID-19.

Methods

Design

We conducted a systematic review of qualitative studies following the methods described in the Cochrane handbook of systematic reviews and outlined in the Cochrane guidance on conducting rapid qualitative evidence synthesis (QES).27,28,29 The review protocol was registered and published with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42022356698). Findings from this rapid QES are reported using the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) checklist.30

Search strategy

We searched MEDLINE (Ovid) and the WHO COVID-19 register from 01 January 2020 to 07 September 2022. We also searched the reference list of all included studies, including related systematic reviews, to identify any additional potentially eligible studies for inclusion. We used terms such as ‘COVID-19 Testing or COVID*’ or ‘SARS-CoV-2’ or ‘coronavirus*’ or ‘COV’ or ‘NCOV’ for Medline, and for WHO COVID-19 register, we used ‘(test or tests or testing) AND (transmission or replication or prevent* or transmit* or spread* or contain or containment or proliferat*) and (‘adhere to’ or adherence or attitude* or barriers or behaviour or behaviour or challeng* or compliance or comply* or facilitat* or influenc* or knowledge or perception* or practice*) and (focus group* or qualitative or ethnograph* or fieldwork or ‘field work’ or ‘key informant’ or interview* or discussion* or questionnaire* or survey* or experience* or narration or ‘personal narrative’ or ‘self report’ or type_of_study:(‘qualitative_research’)) and la:(‘en’) and type:(‘article’).

Details of the search strategy, including the search terms, and the Boolean operators for each database are outlined in Online Appendix 1.

Study selection and sampling

All search hits were imported into the Endnote Reference Management software where duplicates and irrelevant items were automatically removed. The authors then proceeded with screening of the remaining records in three stages. Titles and abstracts were screened first using an eligibility criteria form, followed by full-text screening and then sampling. Screening was completed in pairs, one author screened all titles, abstracts and full texts of potentially eligible studies using a pre-piloted eligibility screening form. A second author, verified all output from each of these stages. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and flow diagram to report the search and selection of studies (Figure 1).31

FIGURE 1: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of included studies.

Author pairs resolved discrepancies in the study selection process by consulting a third review author. Full-text screening yielded 30 studies. We considered this number too large to analyse adequately, considering the short time frame for the review and therefore purposively sampled papers using maximum variation sampling.32,33,34 We developed a three-step sampling frame with the following parameters: closeness of the study to our synthesis objective, geographical spread or representation and data richness using the data richness scale.35

Online Appendix 2 provides references and details of included but not sampled studies.

Inclusion criteria

Table 1 outlines the inclusion criteria. We used the setting, perspective, phenomenon of interest, comparison and evaluation (SPICE) framework to help shape the review question and articulate the inclusion criteria.36 Because of the short time frame of the review, we included only published studies in English. We did not exclude any study based on our assessment of methodological limitations.

TABLE 1: Inclusion criteria.
Data extraction

Key study characteristics and outcomes were extracted using a pre-piloted data extraction spreadsheet in Microsoft (MS) Excel. Two additional MS Excel spreadsheet were used to extract themes and supporting quotes relevant to the review objectives. Details of themes and supporting quotes are presented in Table 3. For facilitators and barriers, we extracted information on factors at the individual, provider, health system, community and social-political levels, and mapped this onto elements of the Supporting the use of Research Evidence (SURE) framework.37 Two review authors (U.J.A. and P.N.O.) extracted data from the sampled studies, and one author (N.S.N.) verified all extracted data for accuracy and completeness. Disagreements were resolved by a third author (D.I.A.) or by consulting other review authors in the team.

Assessment of methodological limitations of sampled studies

An adapted version of the Critical Appraisal Skills Programme (CASP) tool for qualitative studies37 was used for assessment of the methodological limitations of the sampled studies. The tool adapted, contains seven items evaluating the (1) appropriateness or adequacy of descriptions of the study context and setting(s), (2) sampling strategy, (3) data collection, (4) data analysis, (5) evidence supporting the findings, (6) evidence of reflexivity and (7) ethical considerations. No study was excluded based on the quality assessment.

Review author reflexivity

All the authors experienced the COVID-19 pandemic and generally considered IPC strategies essential for mitigating the spread of the virus. Before the review commenced, all authors declared no conflict of interest about the study. Throughout the review process, the authors were mindful of their inclinations. They minimised bias in the analysis and interpretation of the review findings by discussing and agreeing on the review findings as a team. The multi-disciplinary nature of the team allowed for rich insights and balanced views on the findings and interpretation of the evidence.

Data synthesis

The thematic synthesis approach38 was manually used to synthesise relevant qualitative data. This allowed us to generate descriptive themes directly from the data and categorise them using inductive and ‘constant comparison’ methods.39 This approach is suitable for exploring the perspectives and experiences of stakeholders40,41 and involves familiarisation with the data (initial coding), coding the texts (line-by-line coding), developing descriptive themes and generating analytical themes. To synthesise data on factors influencing uptake of diagnostic test interventions, we used a ‘Best-fit’ framework synthesis method.42 The ‘Best-fit’ framework synthesis uses deductive methods to fit the findings of qualitative studies into a pre-existing framework. We adopted the SURE framework37 as the appropriate framework for this synthesis because it identifies factors that influence the implementation of a policy option at the level of the care recipient, care provider, health service and system constraints, and the social and political context. Once we had identified descriptive themes, we then refined these into analytical themes. This involved going beyond the content of the original studies to address the aspects important to help the guideline development group use this qualitative evidence to inform their decision-making on the recommendations (D.I.A., H.S., N.S.N. and E.A.O. analysed the data.).

Assessing confidence in the review findings

We used the Grading of Recommendations Assessment, Development, and Evaluation and the Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach43 to assess the confidence level (high, moderate, low or very low) in each review finding. This assessment is made across four domains (methodological limitations of included studies, coherence of the review finding, adequacy of the data contributing to a review finding and relevance of the included studies to the review question). Two review authors assessed the confidence of each finding across the four domains, with the overall assessment based on the consensus of all review authors.

Ethical considerations

This article followed all ethical standards for research without direct contact with human or animal subjects.

Results

Search results

The initial title and abstract screening yielded 39 studies likely for inclusion out of the 886 studies from the search output. After full-text screening, 30 studies met inclusion criteria and were further subjected to purposive sampling which yielded 22 studies for the final QES based on relevance, geographical spread and depth of insight. Details of study selection process are captured in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram (Figure 1). Online Appendix 2 provides the references and characteristics of included but not sampled studies.

Description of included studies

Table 2 summarises the characteristics of sampled studies. Included studies were from high-income countries (HICs: England, Germany, the Netherlands, South Australia, United States [US]) (n = 20) and low- and middle-income countries (LMICs: The Philippines and Nepal) (n = 2).

TABLE 2: Characteristics of included studies and the overall assessment of limitations.

All the 22 studies included for qualitative synthesis were primary qualitative studies. One of the studies collected local narratives from local community media and social media, while another study used an open-ended questionnaire format to collect qualitative data. The remaining 20 studies used focus group discussions (FGDs) and/or interviews to collect data (Table 2).

Among the sampled studies, two were conducted in healthcare facilities, two in care homes and 18 in community settings. Of the two health facility-based studies, the participants in one were recipients of care and the second were healthcare workers. The two care home studies involved different cadres of health workers directly and indirectly involved in patient care. Both studies focussed on implementation of testing policies. Participants in the community-based studies included the homeless and unsheltered (Table 2). Nineteen studies out of the 22 included reported on barriers and facilitators to uptake of diagnostic test interventions while 11 studies from the 22 included studies reported on perceptions and experiences of health workers, recipients of care and community members.

Assessment of methodological quality

The methodological quality of the studies ranged from moderate limitations (n = 2) to no limitations (n = 2) and minor methodological limitations (n = 18) (Table 4). In the two studies with moderate methodological limitations and one study with minor methodological limitation, participants received monetary compensation for participation. Most studies provided descriptive information on the study context, sampling strategy, data collection and analysis approaches, and ethical considerations. They also offered basic data to support their findings. None of the studies clearly reported on researcher reflexivity. Table 2 details the characteristics of included studies and the overall assessment of methodological limitation.

Qualitative synthesis findings

We identified 31 descriptive themes and refined these into 13 analytical themes (Table 3). The descriptive themes summarise perceptions, experiences and factors influencing uptake of diagnostic tests; the analytical themes represent re-grouped and refined descriptive themes. Using the GRADE CERQual tool, we assessed the confidence in each finding and graded 12 out of 13 findings as moderate confidence and one finding as low confidence. Table 4 presents a summary of the qualitative findings and CERQual assessments, and next we report the findings under each analytical theme.

TABLE 3: Synthesis results (themes and supporting quotes).
TABLE 4: Summary of qualitative findings and CERQual assessment.
Finding 1: Testing provokes multiple fears among the public (moderate confidence)

In nine studies conducted in HICs, community members expressed fear of the risk of contracting COVID-19 at test centres, preferring a home test instead. In addition, reservations were expressed about the test procedure because of discomfort and pain. Another form of fear expressed was the socio-economic implications of having a positive test result. Individuals worried they could lose their income or job because of their inability to work. Interestingly, these multiple fears were expressed across all the studies in HICs.

In two studies conducted in US among Latinx and Indigenous Latin American immigrant communities and black adults, individuals were hesitant to get tested because of their immigration status. They feared that turning up for a test would put them at risk of being identified by the authorities because they were unsure if testing service would share their personal data. Perceived systemic racism made them less prioritised for COVID-19 care.

Finding 2: Beliefs and behaviour surrounding testing (moderate confidence)

Evidence from 14 studies conducted in 3 HICs and 1 LMIC showed that the perceived threat of and susceptibility to COVID-19 motivated community members to get tested. Persons with co-morbidity felt vulnerable and at high risk of severe illness if they got infected with the virus. Some persons were unwilling to test in a bid to avoid the implications of a positive test result on their immediate community. They feared they would be quarantined if anyone tested positive because they lived or worked in crowded environments. However, in contrast to the previous perception, some community members felt the moral obligation to get tested to protect their family, the vulnerable and their immediate community. For others, a negative test result was reassuring because they will not be a source of infection in the household, community or workplace. These perceptions reflect responses from studies from both HICs and LMICs.

Finding 3: Testing preferences (moderate confidence)

Evidence from six studies conducted in HICs revealed the preference for less invasive tests such as the saliva test compared to the swab test by community members and residents of care homes. Saliva tests were also perceived to be more convenient; although, participants generally complained of discomfort such as pain, which are transient.

Finding 4: Questioning the need for testing (moderate confidence)

Seven studies reporting community members’ perspectives conducted from HICs questioned the need for asymptomatic testing when they had followed the COVID-19 guidelines, were never sick, never had any symptoms or knew any confirmed cases of COVID-19. There was also a perception that vaccination removed the need for testing hence the question on why vaccinated persons should get tested, because testing does not stop transmission or remove the likelihood of getting re-infected with the virus.

Finding 5: Deciding whether to test (moderate confidence)

Six studies conducted in HICs show the decision to get tested was largely informed by the individual’s self-assessment of symptoms. Willingness to get tested was based on having two or more classic symptoms of COVID-19 or felt sick enough, especially after possible exposure.

Finding 6: In principle support for diagnostic testing (moderate confidence)

Community members in six studies, conducted in HICs, expressed support for frequent or universal asymptomatic testing. This is because they perceived frequent testing (daily or weekly) would give them a sense of reassurance that they were not infected especially if they had interacted with others socially.

Finding 7: Concerns about test accuracy and reliability (moderate confidence)

Eleven studies conducted in HICs expressed concerns about the accuracy and reliability of test results from community members and healthcare workers. These concerns include high rates of false positives and false negative results. In addition to this was the cost of having to repeat the test when the result is unreliable or decisions are made based on inaccurate results. Community members also perceived lateral flow tests to be less accurate than polymerase chain reaction (PCR) test and were not confident in their ability to conduct self-tests at home.

Finding 8: Convenience of testing (moderate confidence)

Nine studies from HICs, consisting of one study involving staff of care homes and eight involving community members, reported concerns about accessibility; particularly vehicular access and convenience of testing centres in the community especially for the elderly. The study involving care home staff from England was concerned about inconvenience of managing testing procedures.

Finding 9: Opportunity costs (low confidence)

One study conducted in Australia showed there was an opportunity cost associated to testing which was the cost of isolating while waiting for test results. Community members complained about the inability to sit for an examination as it was necessary to self-isolate until the test result is out, and the increased cost of living because meals had to be ordered from food outlets.

Finding 10: Affordability (moderate confidence)

Five studies, four from a HIC and one from LMIC, among community members were concerned about the perceived high cost of self-testing and its sustainability. In their opinion, free tests will motivate more persons to get tested.

Finding 11: Service delivery factors influencing uptake of testing (moderate confidence)

Ten studies from four HICs and one in a LMIC reported several service delivery factors including availability, accessibility, queues and long waiting time for tests and test results.

Although they desired to be tested, their experience of long queues after which they may still not get tested discouraged testing. Sometimes getting tested required commuting to another town. These barriers coupled with the anticipated consequences of a positive test (isolation), conditioned people to only seek tests based on symptom recognition.

Finding 12: Policy and political factors (moderate confidence)

Evidence from six studies illustrates the gap between policy and implementation, the influence of incentives, as well as the lack of trust in government and health workers as socio-political factors influencing diagnostic test uptake. These studies were conducted in two HICs and one LMIC. Two studies, one from an HIC and another from an LMIC, show that government mandate can either discourage or prompt people to test. In addition, the study from LMIC strongly expressed a lack of synergy among the tiers of government regarding testing. A study from an HIC expressed strong reservation about forceful testing mandate and another pointed out corruption in government and the lack of trust for health workers (Doctors) and people based on the Tuskegee incident where people of colour were used as experimental beings rather than humans for testing as barriers.

Finding 13: Social factors (moderate confidence)

Eleven studies, conducted in two HICs and one in an LMIC, identified misconceptions, conspiracy theories, rumours, stigmatisation and discrimination of persons who got tested or persons who tested positive. Therefore, community members avoided getting tested for fear of being shamed, blamed, isolated and stigmatised. Individuals also experienced backlash and blame from health workers for not following guidelines and putting others at risk in the US. Because of this anticipated fear, those who had tested, concealed from others that they had been tested, while others out of fear opted not to get tested.

Discussion

Summary of main results

Summary of main results are outlined in Table 4.

Description of studies

Our review aimed to identify and synthesise the findings of qualitative studies on the perceptions, experiences and views of community members, healthcare providers and recipients of care on diagnostic test interventions, and on barriers and facilitators to uptake of diagnostic test interventions in the context of COVID-19. Most of the studies were conducted in HICs (US, England, and Europe) and explored views and perspectives of community members in the community setting.

Factors influencing uptake

Major themes of low to moderate quality evidence centred around fear of the implication of a positive test, beliefs, misconceptions and myths, concern about test accuracy and reliability, convenience and cost of testing, policy and implementation issues, as well as social, political and community factors.19,64,65 The implication of this finding, hinges on the role of fear and misinformation as barriers to the uptake of diagnostic tests among the sampled population. The consequences of a positive test (quarantine) which isolates the individual from family and community members were not acceptable. The accuracy and reliability of the antibody and antigen tests were questioned probably because of the variation in test results on account of the antibody level in the antibody tests and viral load in the antigen tests. Other barriers to uptake were fear of testing procedures, and discomfort associated with testing, which were considered too invasive and uncomfortable especially for the nasopharyngeal or oropharyngeal swabs.66,67 Some questioned the need for asymptomatic testing.68,69 However, others expressed support for frequent or universal asymptomatic testing because it gave them a sense of reassurance.70,71 This review also identified conspiracy theories, illegal immigration status and perceived racism as barriers.

Overall, fear and beliefs are prominent in high-income settings especially fear and belief of perceived vulnerability and susceptibility. In HICs where we found information, people questioned the need for testing when other control measures are in place (e.g. vaccines). Questioning the need for testing may be linked to misconceptions largely centred on symptom presentation and the lack of clarity of government policy in some countries on testing for symptomatic and asymptomatic individuals. Concerns about accuracy and reliability are real and are attributed to the high number of false positive and negative tests. Service delivery factors expressed as barriers were mainly availability and accessibility.

This review has consolidated findings on community-level misconceptions, conspiracy theories and rumours that appear to extend across HICs and LMICs. Despite wide spread fears and concern about diagnostic test for COVID-19 among community members, some respondents supported testing and saw the need to be tested to protect family members and the community and have reassurance that they are not positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

Strengths of the study

The comprehensive search, we think identified almost all the qualitative studies conducted and reported in English during the period. We used the SPICE framework to help shape the review question and articulate the inclusion criteria.

Limitations of the study

The rapid search method and our search of the English language literature only, meaning that we may have missed eligible studies and other studies reported in other languages – for example from Francophone West Africa, and Latin America. This review included studies mostly carried out in developed countries, and none from Africa. The two studies from LMICs, contributed very little to the review findings. Furthermore, there was insufficient evidence from health workers perspective.

Gaps and implications for practice, policy and research

The implication of our review findings for practice, points to the need for educating communities and providing more information and health promotion material to counteract the misconceptions, rumours as well as beliefs and fears surrounding testing. For policy, findings suggests a gap between policy and implementation, the influence of incentives, as well as the lack of trust in government and health workers. Therefore, well defined polices with stakeholder engagement and a robust implementation monitoring strategy to get feedback can mitigate this gap. Although this finding is from HICs, it may be applicable to other settings. For research, there is the need for more studies in the healthcare setting, involving healthcare workers perspective as these are crucial stakeholders in IPC. The two studies from Nepal and The Philippines contributed to four themes, but we cannot be certain these reflect experiences and perceptions in other LMICs. Should another pandemic occur there is a need to deploy rapid qualitative methods quickly and in a coordinated way across multiple countries, especially in Africa. This should include ‘social listening’ and monitoring of social media for real-time on the ground beliefs and perceptions.

Conclusion

Uptake of diagnostic test interventions were influenced by multiples factors, operating at the individual, community and institutional level.

Emerging themes revolved around fear of test procedure and socio-economic implication of positive test, beliefs of vulnerability and susceptibility, test preferences, accuracy, reliability, cost and affordability, testing experiences, service delivery factors such as long queues at testing centres, social, political and community factors, all shaped perception and uptake. These were largely based on misconception, misinformation, and the lack of trust from community members, while adaptation to managing testing procedures, implication of positive test to the health workforce and frequent changes to guideline were important factors that shaped support or otherwise for diagnostic test from health workers.

In conclusion, this review found a low to moderate quality evidence of barriers to uptake of diagnostic testing largely because of misconceptions about the intervention. It is recommended that community sensitisation targeting misconceptions and stakeholder engagement among healthcare workers will improve uptake and bridge the policy implementation gap. Applicability of our review findings in LMICs is limited because only two studies from LMICs contributed data to this QES.

Acknowledgements

We thank colleagues at Infection Prevention and Control, Country Readiness Strengthening, World Health Organization, World Health Emergencies Programme, Geneva, Switzerland, for their support during the preparation of the review.

Competing interests

This publication received research funding from Country Readiness Strengthening, WHO World Health Emergencies Programme, Geneva, Switzerland, to Cochrane Nigeria, which is developing products related to the research described in this publication. The terms of this arrangement have been reviewed and approved by the university in accordance with its policy on objectivity in research.

Authors’ contributions

H.S., D.I.A. and M.M. designed the review protocol. N.S.N., U.J.A., P.N.O. and D.I.A. screened and extracted data. D.I.A., H.S., E.A.O. and N.S.N contributed to data synthesis. N.S.N. wrote the first draft of the article with input from E.A.O., H.S. and D.I.A. All authors read and approved the final article.

Funding information

The review was funded by a grant from Country Readiness Strengthening, WHO World Health Emergencies Programme, Geneva, Switzerland, to Cochrane Nigeria.

Data availability

Data and materials used for the study are available from the corresponding author, N.S.N., and also its supplementary materials (Online Appendix 1 and 2).

Disclaimer

The views and opinions expressed in this article are those of the authors and are the product of professional research. The article does not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The authors are responsible for this article’s results, findings and content.

References

  1. Infection prevention and control in the context of coronavirus disease (COVID-19): A living guideline. 2023 [cited 2023 Dec 28]. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-IPC-guideline-2023.3
  2. Liang LL, Kao CT, Ho HJ, Wu CY. COVID-19 case doubling time associated with non-pharmaceutical interventions and vaccination: A global experience. J Glob Health. 2021;11:05021. https://doi.org/10.7189/jogh.11.05021
  3. Güner HR, Hasanoğlu İ, Aktaş F. COVID-19: Prevention and control measures in community. Turkish J Med Sci. 2020;50(9):571–577. https://doi.org/10.3906/sag-2004-146
  4. Peeling RW, Olliaro PL, Boeras DI, Fongwen N. Scaling up COVID-19 rapid antigen tests: Promises and challenges. Lancet Infect Dis. 2021;21(9):e290–e295. https://doi.org/10.1016/S1473-3099(21)00048-7
  5. Mboowa G. Current and emerging diagnostic tests available for the novel COVID-19 global pandemic. AAS Open Res. 2020;3:8. https://doi.org/10.12688/aasopenres.13059.1
  6. Peeling RW, Heymann DL, Teo YY, Garcia PJ. Diagnostics for COVID-19: Moving from pandemic response to control. Lancet. 2022;399(10326):757–768. https://doi.org/10.1016/S0140-6736(21)02346-1
  7. Zhang D, Kukkar D, Kim KH. Immunological tests: Essential and supportive tools in the fight against COVID-19. TrAC Trends Anal Chem. 2023;168:117291. https://doi.org/10.1016/j.trac.2023.117291
  8. Toft CJ, Bourquin RA, Sorenson AE, Horwood PF, Druce JD, Schaeffer PM. Analytical sensitivity of COVID-19 rapid antigen tests: A case for a robust reference standard. Talanta Open. 2023;7:100187. https://doi.org/10.1016/j.talo.2023.100187
  9. Deb P, Furceri D, Ostry JD, Tawk N. The effect of containment measures on the COVID-19 pandemic. Epidemiol Health. 2020;42:e2020035. https://doi.org/10.5089/9781513550268.001
  10. Pung R, Cook AR, Chiew CJ, et al. Effectiveness of containment measures against COVID-19 in Singapore: Implications for other national containment efforts. Epidemiology (Cambridge, Mass.). 2021;32(1):79. https://doi.org/10.1097/EDE.0000000000001257
  11. Bosetti P, Tran Kiem C, Andronico A, et al. Epidemiology and control of SARS-CoV-2 epidemics in partially vaccinated populations: A modeling study applied to France. BMC Med. 2022;20(1):33. https://doi.org/10.1186/s12916-022-02235-1
  12. Salathé M, Althaus CL, Neher R, et al. COVID-19 epidemic in Switzerland: On the importance of testing, contact tracing and isolation. Swiss Med Weeky. 2020;150(1112):w20225.
  13. Walque D, Friedma D, Gatti JA, Mattoo RA, How two tests can help contain COVID-19 and revive the economy. World Bank Research and Policy Briefs No. 147504. 2020 [cited 2022 Dec 18]. Available from: https://ssrn.com/abstract=3590818
  14. Drain PK. Rapid diagnostic testing for SARS-CoV-2. N Engl J Med. 2022;386(3):264–272. https://doi.org/10.1056/NEJMcp2117115
  15. Jian MJ, Perng CL, Chung HY, et al. Clinical assessment of SARS-CoV-2 antigen rapid detection compared with RT-PCR assay for emerging variants at a high-throughput community testing site in Taiwan. Int J Infect Dis. 2022;115:30–34. https://doi.org/10.1016/j.ijid.2021.11.034
  16. Budd J, Miller BS, Weckman NE, et al. Lateral flow test engineering and lessons learned from COVID-19. Nat Rev Bioeng. 2023;(1):13–31. https://doi.org/10.1038/s44222-022-00007-3
  17. Bleasdale J, Leone LA, Morse GD, Liu Y, Taylor S, Przybyla SM. Socio-structural factors and HIV care engagement among people living with HIV during the COVID-19 pandemic: A qualitative study in the united states. Trop Med Infect Dis. 2022;7(10):259. https://doi.org/10.3390/tropicalmed7100259
  18. Adedeji-Adenola H, Olugbake OA, Adeosun SA. Factors influencing COVID-19 vaccine uptake among adults in Nigeria. PLoS One. 2022;17(2):e0264371. https://doi.org/10.1371/journal.pone.0264371
  19. Embrett M, Sim SM, Caldwell HA, et al. Barriers to and strategies to address COVID-19 testing hesitancy: A rapid scoping review. BMC Public Health. 2022;(1):10. https://doi.org/10.1186/s12889-022-13127-7
  20. Lee RM, Handunge VL, Augenbraun SL, et al. Addressing COVID-19 testing inequities among underserved populations in Massachusetts: A rapid qualitative exploration of health center staff, partner, and resident perceptions. Front Public Health. 2022;10:838544. https://doi.org/10.3389/fpubh.2022.838544
  21. Sakala M, Johnson C, Chirombo J, Sacks JA, Baggaley R, Divala T. COVID-19 self-testing: Countries accelerating policies ahead of WHO guidelines during pandemics: A Global Survey. medRxiv. 2023:2023–08. https://doi.org/10.1101/2023.08.23.23294474
  22. Undelikwo VA, Shilton S, Folayan MO, Alaba O, Reipold EI, Martínez-Pérez GZ. COVID-19 self-testing in Nigeria: Stakeholders’ opinions and perspectives on its value for case detection. PLoS One. 2023;18(4):e0282570. https://doi.org/10.1371/journal.pone.0282570
  23. Garcini LM, Pham TT, Ambriz AM, Lill S, Tsevat J. COVID-19 diagnostic testing among underserved Latino communities: Barriers and facilitators. Health Soc Care Community. 2022;(5):e1907–e1916. https://doi.org/10.1111/hsc.13621
  24. Hannay E, Pai M. Breaking the cycle of neglect: Building on momentum from COVID-19 to drive access to diagnostic testing. EClinicalMedicine. 2023;57:101867. https://doi.org/10.1016/j.eclinm.2023.101867
  25. Sripad P, Gottert A, Abuya T, et al. Confirming—and testing—bonds of trust: A mixed methods study exploring community health workers’ experiences during the COVID-19 pandemic in Bangladesh, Haiti and Kenya. PLOS Glob Public Health. 2022;2(10):e0000595. https://doi.org/10.1371/journal.pgph.0000595
  26. Gehlbach D, Vázquez E, Ortiz G, et al. Perceptions of the Coronavirus and COVID-19 testing and vaccination in Latinx and Indigenous Mexican immigrant communities in the Eastern Coachella Valley. BMC Public Health. 2022;22(1):1019. https://doi.org/10.1186/s12889-022-13375-7
  27. Biesty L, Meskell P, Glenton C, et al. Quest for speed: Rapid qualitative evidence syntheses as a response to the COVID-19 pandemic. Syst Rev. 2020;9(1):1–6. https://doi.org/10.1186/s13643-020-01512-5
  28. Garritty C, Gartlehner G, Nussbaumer-Streit B, et al. Cochrane Rapid Reviews Methods Group offers evidence-informed guidance to conduct rapid reviews. J Clin Epidemiol. 2021;130:13–22. https://doi.org/10.1016/j.jclinepi.2020.10.007
  29. Houghton C, Meskell P, Delaney H, et al. Cochrane Effective Practice and Organisation of Care Group, Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: A rapid qualitative evidence synthesis. Cochrane Database Syst Rev. 2020;8:CD013582. https://doi.org/10.1002/14651858.CD013582
  30. Tong A, Flemming K, McInnes E, et al. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;12(1):1–8. https://doi.org/10.1186/1471-2288-12-181
  31. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Br Med J. 2021;372:n71. https://doi.org/10.1136/bmj.n71
  32. Patton MQ. Qualitative research and evaluation methods. Thousand Oaks, CA: Sage; 2002, p. 4.
  33. Chatterjee S, Bhattacharya M, Nag S, et al. A detailed overview of SARS-CoV-2 omicron: Its sub-variants, mutations and pathophysiology, clinical characteristics, immunological landscape, immune escape, and therapies. Viruses. 2023;15(1):167. https://doi.org/10.3390/v15010167
  34. Effective Practice and Organisation of Care (EPOC). Qualitative Evidence Synthesis. Guidance on when to sample and how to develop a purposive sampling frame. EPOC resources for review authors. 2019 [cited 2022 Dec 18]. Available from: https://epoc.cochrane.org/sites/epoc.cochrane.org/files/public/uploads/Resources-forauthors2017/qes_guidance_on_sampling.pdf
  35. Suri H. Purposeful sampling in qualitative research synthesis. Qual Res J. 2011;11(2):63–75. https://doi.org/10.3316/QRJ1102063
  36. Booth A, Noyes J, Flemming K, et al. Formulating questions to explore complex interventions within qualitative evidence synthesis. BMJ global health. 2019;1(4)(Suppl 1):e001107. https://doi.org/10.1136/bmjgh-2018-001107
  37. Ames H, Glenton C, Lewin S. Purposive sampling in a qualitative evidence synthesis: A worked example from a synthesis on parental perceptions of vaccination communication. BMC Med Res Methodol. 2019;19(1):1–9. https://doi.org/10.1186/s12874-019-0665-4
  38. The SURE Collaboration. Guides for preparing and using evidence-based policy briefs: 5 identifying and addressing barriers to implementing policy options. Version 2.1. 2011 [cited 2022 Dec 18]. Available from https://epoc.cochrane.org/
  39. Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8(1):1–0. https://doi.org/10.1186/1471-2288-8-45
  40. Miles MB, Huberman AM. Qualitative data analysis: An expanded sourcebook. Thousand Oaks: Sage; 1994.
  41. Harden A, Garcia J, Oliver S, et al. Applying systematic review methods to studies of people’s views: An example from public health research. J Epidemiol Community Health. 2004;58(9):794–800. https://doi.org/10.1136/jech.2003.014829
  42. Noyes J, Booth A, Flemming K, et al. Cochrane Qualitative and Implementation Methods Group guidance series—Paper 3: Methods for assessing methodological limitations, data extraction and synthesis, and confidence in synthesized qualitative findings. J Clin Epidemiol. 2018;97:49–58. https://doi.org/10.1016/j.jclinepi.2017.06.020
  43. Carroll C, Booth A, Leaviss J, Rick J. “Best fit” framework synthesis: Refining the method. BMC Med Res Methodol. 2013;13(1):1–6. https://doi.org/10.1186/1471-2288-13-37
  44. Bateman LB, Schoenberger YM, Hansen B, et al. Confronting COVID-19 in under-resourced, African American neighborhoods: A qualitative study examining community member and stakeholders’ perceptions. Ethn Health. 2021;26(1):49–67. https://doi.org/10.1080/13557858.2021.1873250
  45. Gierszewski D, Kurotschka PK, Krauthausen M, et al. Parents’ and childcare workers’ perspectives toward SARS-CoV-2 test and surveillance protocols in pre-school children day care centers: A qualitative study within the German Wü-KiTa-CoV project. Front Med. 2022;9:897726. https://doi.org/10.3389/fmed.2022.897726
  46. Knight KR, Duke MR, Carey CA, et al. COVID-19 testing and vaccine acceptability among homeless-experienced adults: Qualitative data from two samples. J Gen Intern Med. 2022;37(4):823–829. https://doi.org/10.1007/s11606-021-07161-1
  47. Lorenc A, Kesten JM, Kidger J, Langford R, Horwood J. Reducing COVID-19 risk in schools: A qualitative examination of secondary school staff and family views and concerns in the South West of England. BMJ Paediatr Open. 2021;5(1):e000987. https://doi.org/10.1136/bmjpo-2020-000987
  48. Mathers J, Poyner C, Thompson D, Rudge G, Pritchett RV. Exploration of the uptake of asymptomatic COVID-19 lateral flow testing in Birmingham, UK: Survey and qualitative research. BMJ Open. 2022;12(4):e056606. https://doi.org/10.1136/bmjopen-2021-056606
  49. Nwaozuru U, Obiezu-Umeh C, Diallo H, et al. Perceptions of COVID-19 self-testing and recommendations for implementation and scale-up among Black/African Americans: Implications for the COVID-19 STEP project. BMC Public Health. 2022;22(1):1220. https://doi.org/10.1186/s12889-022-13619-6
  50. Robin C, Symons C, Carter H. Local community response to mass asymptomatic COVID-19 testing in Liverpool, England: Social media analysis. JMIR Form Res. 2022;6(8):e34422. https://doi.org/10.2196/34422
  51. DeRoo SS, Torres RG, Ben-Maimon S, Jiggetts J, Fu LY. Attitudes about COVID-19 testing among black adults in the United States. Ethn Dis. 2021;31(4):519. https://doi.org/10.18865/ed.31.4.519
  52. Thorneloe RJ, Clarke EN, Arden MA. Adherence to behaviours associated with the test, trace, and isolate system: An analysis using the theoretical domains framework. BMC Public Health. 2022;22(1):567. https://doi.org/10.1186/s12889-022-12815-8
  53. Tonkin E, Pillen H, Meyer SB, et al. Testing delay in an environment of low COVID-19 prevalence: A qualitative study of testing behaviour amongst symptomatic South Australians. SSM Qual Res Health. 2022;2:100099. https://doi.org/10.1016/j.ssmqr.2022.100099
  54. Unger JB, Soto D, Lee R, Deva S, Shanker K, Sood N. COVID-19 testing in schools: Perspectives of school administrators, teachers, parents, and students in Southern California. Health Promot Pract. 2023;24(2):350–359. https://doi.org/10.1177/15248399211066076
  55. Woodland L, Mowbray F, Smith LE, Webster RK, Amlôt R, Rubin GJ. What influences whether parents recognise COVID-19 symptoms, request a test and self-isolate: A qualitative study. PLoS One. 2022;17(2):e0263537. https://doi.org/10.1371/journal.pone.0263537
  56. Singh DR, Sunuwar DR, Shah SK, et al. Impact of COVID-19 on health services utilization in Province-2 of Nepal: A qualitative study among community members and stakeholders. BMC Health Serv Res. 2021;21:1–4. https://doi.org/10.1186/s12913-021-06176-y
  57. Dodd W, Brubacher LJ, Kipp A, et al. Navigating fear and care: The lived experiences of community-based health actors in the Philippines during the COVID-19 pandemic. Soc Sci Med. 2022;308:115222. https://doi.org/10.1016/j.socscimed.2022.115222
  58. Van den Besselaar JH, Spaargaren M, Smalbrugge M, et al. Implementation of a national testing policy in Dutch nursing homes during SARS-CoV-2 outbreaks. J Am Geriatr Soc. 2022;70(4):940–949. https://doi.org/10.1111/jgs.17687
  59. Blake H, Carlisle S, Fothergill L, et al. Mixed-methods process evaluation of a residence-based SARS-CoV-2 testing participation pilot on a UK university campus during the COVID-19 pandemic. BMC Public Health. 2022;22(1):1470. https://doi.org/10.1186/s12889-022-13792-8
  60. Mowbray F, Woodland L, Smith LE, Amlôt R, Rubin GJ. Is my cough a cold or Covid? A qualitative study of COVID-19 symptom recognition and attitudes toward testing in the UK. Front Public Health. 2021;9:716421. https://doi.org/10.3389/fpubh.2021.716421
  61. Kas-Osoka C, Moss J, Alexander L, et al. African Americans views of COVID-19 contact tracing and testing. Am J Infect Contr. 2022;50(5):577–580. https://doi.org/10.1016/j.ajic.2022.02.032
  62. Martindale AM, Pilbeam C, Mableson H, et al. Perspectives on COVID-19 testing policies and practices: A qualitative study with scientific advisors and NHS health care workers in England. BMC Public Health. 2021;21(1):1216. https://doi.org/10.1186/s12889-021-11285-8
  63. Tulloch JS, Micocci M, Buckle P, et al. Enhanced lateral flow testing strategies in care homes are associated with poor adherence and were insufficient to prevent COVID-19 outbreaks: Results from a mixed methods implementation study. Age Ageing. 2021;50(6):1868–1875. https://doi.org/10.1093/ageing/afab162
  64. Simwinga M, Mahlatsi PA, Molale M, et al. Facilitators and barriers to COVID-19 testing in community and clinical settings: Lessons learned from Lesotho and Zambia. PLOS Global Public Health. 2023;3(10):e0002430. https://doi.org/10.1371/journal.pgph.0002430
  65. Lippi G, Henry BM, Plebani M. An overview of the most important preanalytical factors influencing the clinical performance of SARS-CoV-2 antigen rapid diagnostic tests (Ag-RDTs). Clin Chem Lab Med (CCLM). 2023;61(2):196–204. https://doi.org/10.1515/cclm-2022-1058
  66. Van Rensburg D, Adams AK, Perez G, et al. Factors influencing COVID-19 testing among Native Americans and Latinos in two rural agricultural communities: A qualitative study. Front Public Health. 2023;11:1220052. https://doi.org/10.3389/fpubh.2023.1220052
  67. Izeogu C, Gill E, Van Allen K, et al. Attitudes, perceptions, and preferences towards SARS CoV-2 testing and vaccination among African American and Hispanic public housing residents, New York City: 2020–2021. PLoS One. 2023;18(1):e0280460. https://doi.org/10.1371/journal.pone.0280460
  68. Taylor-Egbeyemi J, Carter H, Robin C. Thematic analysis of national online narratives on regular asymptomatic testing for Covid-19 in schools in England. BMC Public Health. 2023;23(1):1–3. https://doi.org/10.1186/s12889-023-15991-3
  69. Thorpe L, Carter H, Robin C. Engagement with regular asymptomatic COVID-19 testing in young people in North West England: A qualitative focus group study. BMJ Open. 2023;13(6):e069591. https://doi.org/10.1136/bmjopen-2022-069591
  70. Bauld L, Street A, Connelly R, et al. Students’ and staffs’ views and experiences of asymptomatic testing on a university campus during the COVID-19 pandemic in Scotland: A mixed methods study. BMJ Open. 2023;13(3):e065021. https://doi.org/10.1136/bmjopen-2022-065021
  71. Jayes L, Bogdanovica I, Johnston E, et al. Perspectives of attenders and non-attenders to SARS-CoV-2 asymptomatic community testing in England: A qualitative interview study. BMJ Open. 2022;12(9):e064542. https://doi.org/10.1136/bmjopen-2022-064542


Crossref Citations

No related citations found.