Another BAME student participation gap emerges – this time over Covid testing

So a new pre-print (usual caveats about not being peer-reviewed yet) which contains an analysis of voluntary lateral flow testing uptake at a university was always going to be interesting because of what it might tell us about the sector’s ability to communicate with current students when it really needs to.

Here we have a study attempting to assess uptake of LF testing in that pre-Christmas period of late 2020 among University of Bristol students, including demographic variations – along with a look at the longer term acceptability and feasibility of asymptomatic testing and a look at the barriers and facilitators to uptake and effective implementation of testing.

Obviously I’m aware that Bristol is not the whole HE sector and it may be an outlier. As such, it’s spectacularly frustrating that neither DfE nor DHSC set up this kind of monitoring across the sector. We got to Christmas without knowing who had and hadn’t taken part, or why, or whether the LF tests were accurate when PCR confirmed. Most of the sector arguably should have done this sort of monitoring anyway. So well done to Bristol, even if it is now late July 2021.

On the topline, 12,391 LFD tests were conducted on 8025 (22.3%) of the 36,054 students enrolled at the university. Of those tested, 3921 (48.9%) had one test, 3880 (48.3%) had the recommended two tests, 189 (2.4%) had three tests and 35 (0.4%) had four to six tests. Like within other providers, overall participation rates were pretty poor – under one in five, and just one in 10 students had the recommended two LFTs.

Women were more slightly more likely to be tested than men, but the most striking variations were in uptake by ethnic group. Uptake was highest in ethnically White students, with 30.7% taking at least one test. Uptake was lower among all other groups – lowest among students belonging to the Chinese ethnic group (3%), followed by the Black African, Black Caribbean and Black other group (12.3%). It was also low among the Indian, Pakistani and Bangladeshi group (17.5%).

First year students out of halls were less likely to take part than those in halls, and postgraduate taught students were less likely to get tested. Students outside of the University’s Faculty of Science ware less likely to take part than those enrolled on a course in it. And before you ask – a sensitivity multivariable analysis excluding students who were likely not to have been on campus during the testing period did not alter the observed patterns in testing uptake.

On barriers, some students did not take a test because they did not think that tests were required or intended for them (for example a student explained that she had not taken a test at the university because she was not planning to travel away from Bristol). Other students were able and willing to isolate, and considered this preferable to testing, or demonstrated a preference for PCR tests over LFT.

Some students had not taken a test because they had not been aware that testing was available – and some said that more could be done to promote awareness of testing, particularly among those who do not have a strong network of peers. Practical barriers were described including access issues and issues with the timing and location of test sites, and another barrier was concerns of catching the virus at or on route to the testing centre, particularly among those who had to travel long distances. Some considered the risk of exposure to outweigh the benefits of getting tested.

Interestingly, many students had done their own research, had discussions with their friends, family, tutors and lecturers to maximise their knowledge of testing. The researchers argue that this highlights the need for improved communications from universities to enable students to make their own informed decisions – and they highlight other recent research that has shown basic and simple messages may not be suitable for communicating complex information about how to behave during the pandemic. Students “are likely to appreciate having the opportunity to access information about the sensitivity and specificity of the tests”.

One other bit of good news – despite concerns that testing would increase risky contact, they did not find evidence to support this. Students were well informed about the limitations of the tests, and used them with caution to inform behavioural decisions.

As I say, frustrating we didn’t do this exercise nationally at the time. If – and yes it’s an if – it points to the effectiveness of heath participation messaging and could have told us something about likely vaccine take up, we could have acted to work with underrepresented groups to understand and co-produce some targeted participation motivation work by now.

Ho hum. Another one for my “public inquiry” folder.