Mixed-methods exploration of views on choice in a university asymptomatic COVID-19 testing programme

Background: Asymptomatic COVID-19 testing programmes are being introduced in higher education institutions, but stakeholder views regarding the acceptability of mandating or incentivising participation remain little understood. Methods: Mixed-method study (semi-structured interviews and a survey including open and closed questions) in a case study university with a student testing programme. Survey data were analysed descriptively; analysis for interviews was based on the Framework method. Results: 239 people participated in the study: 213 in the survey (189 students, 24 staff), and 26 in interviews (19 students, 7 staff). There was majority (62%) but not universal support for voluntary participation, with a range of concerns expressed about the potentially negative effects of mandating testing. Those who supported mandatory testing tended to do so on the grounds that it would protect others. There was also majority (64%) opposition to penalties for refusing to test. Views on restricting access to face-to-face teaching for non-participants were polarised. Three-quarters (75%) supported incentives, though there were some concerns about effectiveness and unintended consequences. Participants emphasised the importance of communication about the potential benefits of testing. Conclusions: Preserving the voluntariness of participation in student asymptomatic testing programmes is likely to be the most ethically sound policy unless circumstances change.Caitriona Cox, lead researcher, is a National Institute for Health Research (NIHR) academic clinical fellow. This study is funded by Mary Dixon-Woods’ NIHR Senior Investigator award (NF-SI-0617-10026), by the Wellcome Trust through a contract award for a project on ethical issues in COVID-19 testing, and by The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge. THIS Institute is supported by the Health Foundation, an independent charity committed to bringing about better health and healthcare for people in the UK