JMIR Publications

ABSTRACT

Background PCR testing for COVID-19 was crucial in Australia’s prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact, travel and certain professions. However, flu tracking data indicated that half of Australians were not getting tested for symptoms, and little was known about the drivers and barriers of COVID-19 testing as a novel behaviour. Objective We conducted 4 studies to identify and address COVID-19 testing barriers, with a focus on meeting the needs of people with lower health literacy. Methods and Results Study 1 was a national survey in June 2020 (n=1369), where testing barriers were elicited and coded using the COM-B framework (capability-opportunity-motivation-behavior). Barriers were identified in all three categories. Study 2 was a national survey in November 2020 (n=2869) to estimate prevalence of testing barriers and health literacy disparities, which found knowledge gaps for people with lower vs higher health literacy. Study 3 was a randomised experiment testing health literacy-sensitive written information for a wide range of capability/motivation barriers in February-March 2021, but no differences were found compared to government information (n=1314). Study 4 was a randomised experiment testing 2 audio-visual interventions addressing a smaller number of common barriers in November 2021, targeting young adults with lower health literacy. A fact-based animation and Tiktok intervention presenting the same facts in a humorous style both increased knowledge but not testing intentions, compared to government information (n=1527). Conclusions This study identified a wide range of capability, opportunity and motivation barriers to a novel testing behaviour. These barriers were prevalent even in a health system where COVID-19 testing was free and widely available, and additional access barriers have been reported in other contexts. We showed that key capability barriers such as knowledge gaps can be improved with simple audio-visual communication targeting people with lower health literacy. Additional behaviour change strategies are required to address motivational issues to support testing uptake. The findings may inform planning for future COVID-19 variant outbreaks and new public health emergencies where novel testing behaviours are required.