Immunisation forms a cornerstone of public health policy. However, uptake rates of routine vaccines offered in adolescence are sub-optimal. In 2023/24, for example, HPV uptake in England, for example, was 72.9

OBJECTIVE:To assess the quantity and quality of studies investigating the impact of vaccine reactogenicity, defined as local (e.g. injection-site pain, redness, swelling) and systemic (e.g. fever, myalgia, headache) symptoms, on willingness to accept influenza vaccination. METHODS:A systematic review was conducted on literature published from 1979 to May 2024 using 6 databases. Inclusion and exclusion criteria were defined using the SPIDER framework., Studies were restricted to peer-reviewed studies of adults (≥18 years) examining influenza vaccination. Included publications were categorised according to how vaccine side effects were reported i.e. general side effects, general side effects plus contracting influenza, or reactogenicity. National Institutes of Health (NIH) quality assessment tools were used to assess the quality of included publications. RESULTS:Of 462 publications charted, 353 (76 %) reported perceived or experienced general side effects as reasons for non-vaccination; 48 (10 %) reported general side effects and contracting influenza; and 61 (13 %) reported vaccine reactogenicity. Of the 61 studies reporting or specifying reactogenicity, 11 (18 %) reported both experienced and anticipated reactogenicity, 12 (20 %) reported anticipated reactogenicity, and 38 (62 %) reported experienced reactogenicity. Most studies were rated fair quality (n = 57), with two good and two poor. Twenty-one studies investigated associations between reactogenicity and uptake (willingness or actual vaccination). Of these, 11 examined experienced reactogenicity; the majority (9 of 11) found that individuals who experienced local or systemic reactions perceived themselves to be less likely to accept vaccination in future seasons. CONCLUSIONS:While side effects are frequently cited as reasons for non-vaccination, there is a dearth of high-quality studies specifically addressing the impact of reactogenicity on influenza vaccine willingness. Although most suggest a link between experienced reactogenicity and reduced future intention to vaccinate, heterogeneity in study design and quality precludes firm conclusions. Understanding the implications of reactogenicity is essential to inform strategies that improve coverage and guide intervention design.

Invasive group A streptococcal (iGAS) disease is a rare but serious bacterial infection affecting a broad cross-section of people. Public health advice is routinely provided to close contacts of iGAS cases to encourage early presentation to medical facilities, given the elevated risk of secondary transmission. Despite being at heightened risk, people experiencing homelessness (PEH) and people who inject drugs (PWID) have not been involved in developing the pre-existing public health materials, and therefore they may not be accessible, understandable, or actionable for these groups. Coproduction is an approach in which people with lived experience work in partnership with researchers, in this case, to design and evaluate interventions intended for their use. This project (1) explored the experiences and communication needs of PEH and PWID; (2) coproduced iGAS factsheets with PEH and PWID; and (3) evaluated whether the coproduced materials were accessible, understandable, non-stigmatising, and actionable. We used the Agile Co-production and Evaluation (ACE) framework to embed coproduction throughout the development and evaluation of iGAS public health materials, recognising the need for approaches tailored to the contexts and constraints faced by PEH and PWID. A multidisciplinary steering group including public health professionals, service providers, and researchers guided the study. The protocol was pre-registered (OSF: z4268) and the study is reported in accordance with GRIPP2 long-form guidelines for public involvement. Coproduction activities informed factsheet modifications incorporating simplified language, visual cues, and content relevant to PEH and PWID. Coproducers described the new factsheet as eye-catching, easy to read, and person-centred whereas the original version was viewed as having limited relevance. In the evaluation survey, 32/39 responders preferred the coproduced factsheet, which was rated higher for readability and clarity. Symptoms of iGAS were correctly identified and responders reported they would follow the advice. Coproduction can improve the design and evaluation of public health advice for underserved groups. Using the ACE framework, coproduced materials were clearer, more actionable, and better aligned with the needs of PEH and PWID. The process also identified practical considerations for health protection teams and future incident settings.

Post-exposure prophylaxis may be recommended during chemical, biological, radiological or nuclear (CBRN) emergencies and must often be initiated rapidly to be effective. Understanding factors that affect uptake (initiation) and subsequent adherence (completion) will help to minimise barriers and support adherence during emergencies. This systematic review synthesises evidence on factors associated with uptake of and adherence to prophylaxis following exposure to anthrax, radiation, smallpox, or viral pandemic diseases such as influenza or COVID-19. The review was pre-registered (https://osf.io/f5nmw). We searched Medline, Embase, APA PsycINFO, Web of Science, Scopus, the Cochrane Library, and subject specific databases, with no language or date restrictions. PRISMA and synthesis without meta-analysis (SWiM) guidelines were followed alongside NICE recommendations for risk of bias assessment. Data were extracted on factors associated with, and interventions targeting, uptake and adherence to prophylaxis across the four scenarios. Of 17,217 records screened, 21 studies were included. Uptake and adherence varied widely. Evidence on associated factors was inconsistent and generally of low certainty. Few scenario-specific differences were identified; variation was more strongly associated with population and contextual factors. Common barriers included concerns about side effects, low perceived risk, and lack of trust in information sources. Evidence on the effectiveness of interventions was limited to two studies, at high risk of bias. In conclusion, preparedness should prioritise addressing shared motivational and practical barriers across settings. There is a critical need to develop and evaluate interventions to support timely uptake and adherence to prophylaxis before emergencies occur.

Vaccination was a key measure to tackle the Covid-19 pandemic, however adolescents were less likely than adults to accept the vaccine. Low vaccine uptake reduces the effectiveness of vaccination campaigns and threatens global public health. Understanding why adolescents are hesitant to accept new vaccines is therefore crucial to support the development of novel vaccine uptake interventions. Prior reviews have included far fewer citations, excluded qualitative data orstudies after 2022 and have not mapped adolescent Covid-19 vaccine behaviour onto psychological models. This systematic review investigated psychological factors influencing attitudes and intentions toward and uptake of Covid-19 vaccines in adolescents aged 10 to 19 years globally. It mapped results onto the COM-B framework to inform future interventions. Our search identified 25,354 citations, and included 77 in this review. The quality of studies was mixed, predominantly cross-sectional in design. According to our review, key influences on adolescent Covid-19 vaccine behaviour were: i) Reflective motivation (safety concerns, perceived susceptibility to/severity of Covid-19, perceived vaccine effectiveness, ii) Social opportunity (social norms, autonomy and prosocial attitudes), iii) Psychological capability (attitude and knowledge about vaccines). Our review provides new insights into psychological factors influencing adolescent Covid-19 vaccine behaviour, and maps factors to the COM-B model of behaviour change. To improve vaccine uptake, future vaccine interventions should support adolescents to think critically about the pros and cons of vaccines and consider external influences on their decisions.

Background: Self-isolation is a key public health strategy for infectious disease control. Globally implemented during the COVID-19 pandemic, it remains an essential strategy in ongoing mitigation efforts. Healthcare workers (HCWs) often face isolation due to occupational exposure to infectious diseases and may face unique psychological challenges. Aims: This systematic review synthesized evidence on (1) the impact of isolation on HCWs' psychological wellbeing, (2) factors associated with wellbeing, and (3) the effectiveness of interventions to improve wellbeing during or after isolation for COVID-19 . Methods: A pre-registered systematic review (PROSPERO: CRD42024559971) was conducted in accordance with PRISMA and Cochrane guidelines. Searches in PsycInfo, Embase, MEDLINE, PubMed, and grey literature included studies on HCWs' psychological wellbeing during or after self-isolation. Risk of bias was assessed using ROBINS-E or CASP tools. Results: From 20,798 records screened, 19 studies (10 quantitative, 7 qualitative, 2 mixed methods) were included. Quantitative findings on anxiety, depressive, and stress symptoms were inconsistent. Qualitative studies consistently reported distress, loneliness, and stigma. Factors associated with wellbeing included socio-cultural influences and protective factors. No studies assessed interventions targeting wellbeing during self-isolation. Conclusion: Self-isolation appears to have variable effects on HCWs' wellbeing, including significant challenges and opportunities for resilience. Public health strategies should prioritize timely, clear communication, accessible evidence-based psychological support, and practical resources. Future research must prioritize evaluation of interventions to mitigate psychological harm and support HCWs during infectious disease outbreaks. ### Competing Interest Statement This work was carried out at King's College London. LES, RA, and GJR were participants of the UK's Scientific Advisory Group for Emergencies or its subgroups. GJR advised the UK's Office for National Statistics on self-isolation policies-papers related to this work were considered in our review. All authors co-authored papers included in the review process. LES and RA are employees of the UK Health Security Agency. NG has provided advice to NHS England in relation to staff health and runs March on Stress Ltd, which provides mental health-focused training for some NHS organisations. MVS, SKB, and AFM report no competing interests. ### Clinical Protocols ### Funding Statement This study was funded by the National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response, a partnership between the UK Health Security Agency, King's College London and the University of East Anglia. The views expressed are those of the authors and not necessarily those of the NIHR, UKHSA or the Department of Health and Social Care. For the purpose of open access, the author will apply a Creative Commons Attribution (CC BY) licence] to any Author Accepted Manuscript version arising. This research was supported by the The Wellcome Trust through the British Academy/Leverhulme Small Research Grants Scheme (SRG2324\240763) awarded to AFM and GJR. The Health Protection Research Unit in Emergency Preparedness and Response Unit is funded by NIHR as part of award no: NIHR200890 (awarded 1 April 2020). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data are freely available in all included articles. Extracted data can be freely accessed.

Nocebo effects are a heterogenous phenomenon in which contextual cues trigger or exacerbate symptoms independently of active interventions. Suggestion, conditioning, and social observation are widely recognised as hallmark methods for inducing nocebo effects, but the extent to which nocebo effects are differentially influenced by suggestion type (e.g., direct or indirect suggestion) and mode of administration (e.g., verbal, textual, visual, etc.) across symptom domains remains unknown. We conducted a pre-registered meta-analysis (PROSPERO registration number CRD42023402097) to quantitatively synthesize available research on the factors that moderate effects in controlled nocebo experiments. Of 8,469 search results, 105 experiments comprising 5,017 participants and 391 effect sizes were analyzed. A multi-level meta-analysis revealed an overall moderate effect size for nocebo effects, g=0.50, [0.39, 0.62]. The magnitude of symptom expectancy effects was a significant moderator of nocebo effects. Verbal suggestion and social observation yielded moderate and comparable nocebo effects whereas technological devices, sham stimulation, and conditioning were independently associated with the induction of large nocebo effects. Greater specificity in the reporting of nocebo induction methods is required to elucidate the efficacy of different types of suggestions in inducing nocebo effects.

INTRODUCTION:Understanding the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) and changes in demand for related healthcare services is crucial for effective healthcare policy and resource allocation. Clinicians, teachers and charities have reported increasing demand for ADHD assessments in recent years, overwhelming support systems. This review synthesises post-2020 studies of ADHD prevalence and incidence. METHODS:We conducted systematic searches in Web of Science, Embase, Medline, Global Health, and PsycInfo using terms relating to ADHD and prevalence. Additional sources included public health databases, Google, and study reference lists. Studies were included if they contained original data relating to general population rates of ADHD and we extracted data relating to methods of assessment and measures of prevalence and incidence. We followed PRISMA and synthesis without meta-analysis (SWiM) guidelines. RESULTS:Forty studies across 17 countries, with one study spanning 42 countries, were reviewed. No significant rise in ADHD prevalence was found, although incidence was found to vary during the COVID-19 pandemic. Only four of the included studies were at low risk of bias. LIMITATIONS:There are substantial limitations in the quality of the literature included in this review. Due to significant delays in reporting prevalence data, estimates from previous reviews may be inaccurate. There is a lack of healthcare data and no school-level data. CONCLUSIONS:Significant research gaps exist in determining ADHD prevalence and incidence. The highest quality findings do not suggest an increase in prevalence since 2020 but indicate some variability in incidence during the COVID-19 pandemic. Further research is urgently needed to guide clinical practice and public health policy.

BACKGROUND:Healthcare workers (HCW) have an increased risk of measles relative to the general population. Yet, immunity and vaccination rates among this group remain suboptimal. Inaccessible vaccination services, complacency, and a lack of confidence in vaccines can drive vaccine hesitancy among HCW and in the general population. This systematic review aimed to explore the effectiveness of interventions designed to increase measles vaccination among HCW. Due to the similarity in the factors that impact vaccine hesitancy, the scope of this review was extended to interventions assessed in non-HCW adults from whom valuable lessons may be learnt. METHODS:A systematic review was conducted (PROSPERO: CRD42024582349). Embase, Medline, Global Health, APA PsycINFO, HMIC Health management, CINAHL, Scopus, Web of Science, the Cochrane Library and trial registers (ClinicalTrials.gov, ISRCTN, ICTRP) were searched up to 17 March 2025. Articles reporting vaccine uptake or comparing vaccination rates among HCW or adults following an intervention were included. RESULTS:Of the 13,457 academic and 585 trial register records, seven articles relating to HCW and eight to non-HCW adults were included. Twelve of the 15 included studies were observational and only two reported inferential statistics for the outcomes of interest. Risk of bias was high for all but one article, which scored fair. Active identification and invitation to vaccination were the most common interventions for HCW and adults. In both populations, this strategy showed some success, but, due to the observational and descriptive nature of most studies, no firm conclusions can be drawn. Moreover, few studies included educational and policy interventions. CONCLUSION:High-quality research is needed to develop our understanding of the effectiveness of different interventions. This will help healthcare providers and policymakers identify appropriate interventions to increase measles vaccination among HCW and, thus, reduce their risk of infection and contain outbreaks in healthcare facilities.

BACKGROUND:Nocebo responding involves the experience of adverse health outcomes in response to contextual cues. These deleterious responses impact numerous features of mental and physical health but are characterized by pronounced heterogeneity. Suggestion is widely recognized as a contributing factor to nocebo responding but the moderating role of trait responsiveness to verbal suggestions (suggestibility) in nocebo responding remains poorly understood. OBJECTIVE:We conducted a pre-registered meta-analysis (PROSPERO registration number CRD42023425605) to quantitatively synthesize available research on the relationship between suggestibility and nocebo responding. METHODS:Four electronic databases were searched for original studies involving both the assessment of suggestibility and symptom reports in response to an inactive stimulus. RESULTS:Of 7729 search results, 10 articles presenting 13 correlations between suggestibility and nocebo responding were analysed. A random-effects meta-analysis revealed a significant, albeit weak, positive correlation, r = .21 [95% CI: .04, .37], between suggestibility and nocebo responses, such that more highly suggestible individuals displayed larger responses. Sensitivity and meta-regression analyses demonstrated that studies of higher methodological quality, including those that maintained experimenter blinding, exhibited stronger effect sizes. CONCLUSION:These results corroborate proposals that trait responsiveness to verbal suggestions confers greater response to nocebos and warrants renewed attention to the role of suggestibility in symptom induction and perception.

OBJECTIVES:Uptake of protective measures to prevent bird-to-human transmission of avian influenza (AI) (correct use of personal protective equipment [PPE], taking antivirals if recommended) and to increase the timely detection of AI in humans (prompt reporting of symptoms after exposure) is imperfect. The aim of this project was to co-produce public health advice for AI with people who work on infected premises. STUDY DESIGN:Co-production following the Agile Co-production and Evaluation (ACE) framework for developing messaging and guidance. METHODS:We co-produced five factsheets in simple English (1. avian influenza, 2. PPE, 3. Tamiflu® (oseltamivir), 4a. Reporting symptoms and active follow-up, 4b. Reporting symptoms and passive follow-up), with accompanying infographics based on theory, previous literature, behavioural science principles, and stakeholder input. Seventeen people who worked on infected premises including two people who did not speak English gave feedback on sheets and shared their lived experience of working on infected premises. RESULTS:Co-producers generally preferred infographics to factsheets and suggested how sheets could be displayed on farms and disseminated within the poultry farming community. Suggested changes included that phrases should be shortened, amendments made to language and images to align with terms and items used on site, and that images in infographics were sometimes ambiguous if accompanying text was not understood. Co-producers also suggested creating videos to accompany the sheets. CONCLUSIONS:The co-production process helped to develop good working relationships with people who work on infected premises and gave practical insight into their experiences.

Objectives: We tested whether people typically perceived as ‘vulnerable’ by public health and emergency planners self-identify as 'vulnerable' in a disaster, and whether they are registered on a ‘vulnerability list’. Study Design: We collected data from 5,148 UK-based adults using a cross-sectional online survey from July-September 2022, using nationally representative quotas for age, gender, disability, and social grade.Methods: We calculated the proportions of respondents with perceived indicators of ‘vulnerability’ who self-described as 'vulnerable during a disaster’, and who reported being on a Priority Service Register or another ‘vulnerability list’. We used odds ratios to assess whether access to resources or risk mitigation plans explained low rates of self-identification as 'vulnerable' and registration.Results: Self-description as ‘vulnerable in a disaster’ ranged from 22.4% (of people dependent on false teeth) to 60.7% (of people reporting significant difficulty running errands alone). Registration on a Priority Service Register ranged from 11.4% (of people who were pregnant) to 35.7% (of people reporting difficulties dressing, bathing, or using the toilet independently). Respondents without alternative plans or resources were generally no more likely to consider themselves ‘vulnerable’ or be registered than those with alternative plans or resources.Conclusions: Communications using the term 'vulnerable' may not reach target audiences. Using priority lists to reduce health disparities is impractical as most people facing disproportionate risk are not registered. We suggest a shift in UK terminology and discourse surrounding disaster risk and the development of inclusive and equitable strategies for reducing health inequalities in disasters.

AIM:When developing public health measures in a pandemic, it is important to examine attitudes and beliefs relating to vaccination uptake. We report the discrimination of a single-item vaccination intention scale and derive cutpoints in terms of sensitivity (true positives) and specificity (true negatives) in relation to subsequent vaccination status. SUBJECT AND METHODS:In a sample of UK adults (n=1119) recruited through an online survey platform, vaccination intention was measured on a 0-10 numerical rating scale (0=very unlikely, 10=very likely) at the beginning of the UK COVID-19 vaccination rollout (January 2021), and self-reported vaccination status was gathered after vaccination had been offered to all adults (October 2021). Discrimination of the scale was measured by the area under the receiver operating characteristic (ROC) curve. RESULTS:The responders reporting being vaccinated or unvaccinated were 1034 (92.4%) and 85 (7.6%), respectively. The area under the ROC curve was.956 (95% CI.943,.967), indicating a high degree of discrimination. The combined value of sensitivity and specificity was greatest at a cutpoint of 8 on the scale (sensitivity =.821, specificity =.988). If, however, the individual values of sensitivity and specificity are required to be simultaneously optimized, this occurs at point 6 (sensitivity =.886, specificity =.871). CONCLUSION:We recommend a 0-10 intention scale as a validated, practical measure of vaccination intention in public health practice, with a cutpoint of 8 on the scale as optimal, unless sensitivity and specificity are to be simultaneously optimized, when 6 is the optimal cutpoint.

IntroductionHealthcare workers (HCW) are at increased risk of measles due to their occupational exposure. Yet, there is evidence of low vaccination rates, inadequate immunity among this group, and many do not know their vaccination status. The aim of this qualitative study is to explore barriers and facilitators to measles vaccination and reasons why some HCW do not know their vaccination status.MethodsWe conducted 23 online semi-structured interviews with HCW recruited from a teaching hospital in London. HCW were eligible to participate if they had direct patient contact, had not had measles, and were either (a) unsure of their vaccination status, (b) unvaccinated, (c) partially vaccinated, or (d) vaccinated after joining the hospital. We used framework analysis to identify themes and subthemes.ResultsFacilitators to measles vaccination included protection of self and others, being prompted and pragmatic considerations such as being required to be vaccinated for work. Barriers included the accessibility of vaccination, concerns about vaccine safety, and low perceived risk of and from measles. Fractured vaccination records and a lack of perceived importance of measles vaccination may contribute to some HCW not knowing their vaccination status.ConclusionMaking vaccination accessible, increasing knowledge and awareness of measles and measles vaccination, and prompting those who require vaccination may support vaccination decisions. A central, easy-to-access App or portal which sends reminders for boosters may reduce the number of HCW who are unsure of their vaccination status.

Objectives:Upsurges of Group A streptococcus (Strep A) and invasive Group A Strep (iGAS) among children can lead to severe health outcomes. Little is known about parents' information needs during upsurges. Study design:Secondary analysis of an online cross-sectional survey of 503 parents in the UK, conducted during an upsurge of Strep A/iGAS in 2022. Methods:Data were available on perceived severity of Strep A and iGAS, levels of worry, knowledge about their symptoms, and whether parents had sought information and if so what. Results:Thirty-seven participants (7.4 %) had not heard of Strep A, versus 140 (27.8 %) for iGAS. Most participants who had heard of either condition had searched for information, commonly in relation to symptoms. Percentages of participants giving high ratings for severity and worry (scores of 5 or more out of 7) were similar for Strep A (severity: 78.7 %, worry: 65.9 %) and iGAS (severity: 81.1 %, worry: 61.8 %). The only symptoms shown to participants that were correctly identified by more than 50 % were 'flu-like symptoms' (recognised by 51.8 % for Strep A and 40.2 % for iGAS) and sore throat (52.5 % and 37.3 % respectively). There was no association between looking for information, or where participants had received information from, and symptom knowledge scores. Conclusions:High levels of worry existed among parents during the 2022 upsurge in Strep A/iGAS in the UK. This was accompanied by uncertainty about the symptoms associated with Strep A/iGAS and a high desire for more information about symptoms. During future outbreaks, providing clear information about the symptoms to watch out for should continue to be prioritised.

During an emergency, it is necessary to quickly disseminate messages to the public. These communications often provide information about the emergency as well as guidance or advice aimed at ensuring the safety of the population. Successful emergency communication depends upon how rapidly and reliably a message can be disseminated, but also on how people respond to the message that they receive. To assist emergency planners tasked with developing message sets for future incidents, in this paper we report a systematic review of all studies that assessed the impact of mobile telephone alerting systems on intended and actual behaviour, to identify factors that affect their likely impact. We searched multiple databases and conferred with topic experts, resulting in a total of 22 studies which met the inclusion criteria. Our results indicate that limited data exist on how people respond to text-based warning messages and that much of the data is poor quality, indicating a need for more real-world studies.

OBJECTIVES:We aimed to identify psychological factors associated with the use of facemasks in shops in England following removal of legal requirements to do so, and to compare associations with and without legal restrictions.DESIGN:Repeated cross-sectional online surveys (n ≈ 2000 adults) between August 2020 and April 2022 (68,716 responses from 45,682 participants) using quota sampling.METHODS:The outcome measure was whether those who had visited a shop for essentials in the previous seven days reported always having worn a facemask versus sometimes or not at all. Psychological predictor variables included worry, perceived risk and severity of COVID-19 and the perceived effectiveness of facemasks. Socio-demographic variables and measures of clinical vulnerability were also measured. For the period following removal of legal restrictions, multivariable regression was used to assess associations between the primary outcome variable and predictors adjusting for socio-demographic and clinical vulnerability measures. The analysis was repeated including interactions between psychological predictors and presence versus absence of legal restrictions.RESULTS:Worry about COVID-19, beliefs about risks and severity of COVID-19 and effectiveness of facemasks were substantially and independently associated with the use of facemasks. Removal of legal obligations to wear facemasks was associated with a 25% decrease in wearing facemasks and stronger associations between psychological predictors and wearing facemasks.CONCLUSIONS:Legal obligations increase rates of wearing a facemask. Psychological factors associated with wearing a facemask could be targets for interventions aiming to alter rates of wearing a facemask. These interventions may be more effective when there are no legal obligations to wear a face covering in place.

ObjectivesTo investigate worry about COVID-19 during the pandemic, and whether worry was associated with phase of the pandemic, COVID-19 death and incidence rates, Government interventions (including lockdown and advertising), age, being clinically at-risk, ethnicity, thinking that the Government had put the right measures in place, perceived risk of COVID-19 to self and the UK, and perceived severity of COVID-19.DesignSecondary analysis of a series of cross-sectional surveys.Setting73 online surveys conducted for the English Department of Health and Social Care between 28 January 2020 and 13 April 2022.ParticipantsParticipants were people aged 16 years and over living in the UK (approximately 2000 per wave).Primary outcome measuresOur primary outcome was self-reported worry about COVID-19.ResultsRates of being ‘extremely’ or ‘very’ worried changed over time. Worry increased as infection rates increased and fell during lockdowns, but the association became less obvious over time. Respondents aged 60 years and over were less likely to be worried after the launch of the vaccination campaign, while those who were clinically at-risk or from a minoritised ethnic community were more likely to be worried. Higher worry was associated with higher perceived risk, and higher perceived severity of COVID-19. There was no evidence for an association with agreeing that the Government was putting the right measures in place to prevent the spread of COVID-19. The launch of graphic Government advertising campaigns about COVID-19 had no noticeable effect on levels of public worry.ConclusionsIn future infectious disease outbreaks, spikes in worry may attenuate over time, although some sections of society may experience higher anxiety than others.

Background: The twelve item General Health Questionnaire (GHQ-12) is a widely used measure of psychological wellbeing. Because there are seven different sets of response options across the twelve items, there is scope for transcription errors to occur when researchers assemble their study materials. The impact of such errors might be more important if they occur in the first set of response options than if they occur later in the questionnaire, once participants have become aware that options to the right of the GHQ-12 response sets always indicate worse wellbeing.Aims: To test the impact of introducing errors into the first and eighth set of response options for the GHQ-12 that render those response sets partially illogical.Methods: We used a double-blind randomised controlled trial, pre-registered with Open Science Framework (osf.io/syhwf). Participants were recruited by a market research company from their existing panel of respondents in Great Britain. Participants were randomly allocated to receive one of three versions of the GHQ-12: a correct version (n=500), a version with a mistake in the first item (n=502), or a mistake in the eighth item (n=502). Mistakes replaced ‘better than usual’ (item one) or ‘more so than usual’ (item eight) with ‘not at all.’Results: We found no differences between the versions in terms of number of participants with possible poor psychological wellbeing (χ2=0.32, df=2, p=0.85) or in mean GHQ-12 scores for the three groups (F(2, 1501)=0.26, p=0.77).Conclusions: Small deviations from the standard GHQ-12 wording do not have a substantive impact on results.