The Role of Testing Availability on Intentions to Isolate during the COVID-19 Pandemic: A Randomized Trial

Background Little information exists on how COVID-19 testing availability influences intentions to engage in risky behavior. Understanding the behavioral effects of testing availability may provide insight into the role of adequate testing on controlling viral transmission. Objective To evaluate the impact of testing availability on behavioral intention to self-isolate in a simulated scenario with participants who have been clinically diagnosed with COVID-19. Methods A total of 1400 participants were recruited from Amazon Mechanical Turk (MTurk) through a national, online, opt-in survey. Participants were randomized to one of three hypothetical scenarios. Each scenario asked participants to imagine having symptoms consistent with COVID-19 along with a clinical diagnosis from their physician. However, scenarios differed in their testing result: testing unavailable, positive test, or negative test. The primary outcome was intention to engage in high-risk COVID-19 behaviors, measured using an 11-item mean score (range 1-7) that was pre-registered prior to data collection. The randomized survey was conducted between July 23rd to July 29th, 2020. Results Out of 1194 respondents (41.6% male, 58.4% female) with a median age of 38.5 years, participants who had no testing available in their clinical scenario showed significantly greater intentions to engage in behavior facilitating COVID-19 transmission compared to those who received a positive confirmatory test result scenario (difference (SE): 0.14 (0.06), P =0.016), equating to an 11.1% increase in mean score risky behavior intentions. Intention to engage in behaviors that can spread COVID-19 were also positively associated with male gender, poor health status, and Republican party affiliation. Conclusion Testing availability appears to play an independent role in influencing behaviors facilitating COVID-19 transmission. Such findings shed light on the possible negative externalities of testing unavailability. Trial Registration Effect of Availability of COVID-19 Testing on Choice to Isolate and Socially Distance , [NCT04459520][1], ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial Effect of Availability of COVID-19 Testing on Choice to Isolate and Socially Distance, [NCT04459520][1], ### Clinical Protocols ### Funding Statement The Morrison Center for Marketing and Data Analytics ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Board Name: General IRB, UCLA Board Affiliation: Office of the Human Research Protection Program Phone: 310-825-5344 UCLA Office of the Human Research Protection Program (OHRPP) 10889 Wilshire Blvd, Suite 830 Los Angeles, CA 90095-1406 All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. 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 and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes We have archived participant data from the online surveys. This data is available upon request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04459520&atom=%2Fmedrxiv%2Fearly%2F2021%2F03%2F25%2F2021.03.22.21251380.atom