Swansea University Medical School, Swansea University, Swansea, UK
Swansea University Medical School, Swansea University, Swansea, UK.
BMJ Open. 2023 Aug 4;13(8):e073464. doi: 10.1136/bmjopen-2023-073464.
Shielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the first year of the pandemic from March 2020. As the first stage in the EVITE Immunity evaluation (Effects of shielding for vulnerable people during COVID-19 pandemic on health outcomes, costs and immunity, including those with cancer:quasi-experimental evaluation), we generated a logic model to describe the programme theory underlying the shielding intervention.
We reviewed published documentation on shielding to develop an initial draft of the logic model. We then discussed this draft during interviews with 13 key stakeholders involved in putting shielding into effect in Wales and England. Interviews were recorded, transcribed and analysed thematically to inform a final draft of the logic model.
The shielding intervention was a complex one, introduced at pace by multiple agencies working together. We identified three core components: agreement on clinical criteria; development of the list of people appropriate for shielding; and communication of shielding advice. In addition, there was a support programme, available as required to shielding people, including food parcels, financial support and social support. The predicted mechanism of change was that people would isolate themselves and so avoid infection, with the primary intended outcome being reduction in mortality in the shielding group. Unintended impacts included negative impact on mental and physical health and well-being. Details of the intervention varied slightly across the home nations of the UK and were subject to minor revisions during the time the intervention was in place.
Shielding was a largely untested strategy, aiming to mitigate risk by placing a responsibility on individuals to protect themselves. The model of its rationale, components and outcomes (intended and unintended) will inform evaluation of the impact of shielding and help us to understand its effect and limitations.
shielding 旨在保护那些预测在 COVID-19 中风险最高的人，在 2020 年大流行的第一年，英国是唯一实施这种保护的国家。作为 EVITE 免疫评估（COVID-19 大流行期间对脆弱人群进行屏蔽以保护健康、成本和免疫的效果，包括癌症患者：准实验评估）的第一阶段，我们生成了一个逻辑模型来描述屏蔽干预背后的计划理论。
我们回顾了有关屏蔽的已发表文件，以开发逻辑模型的初始草案。然后，我们在与威尔士和英格兰实施屏蔽的 13 名关键利益相关者的访谈中讨论了这一草案。访谈进行了录音、转录，并进行了主题分析，以形成逻辑模型的最终草案。
屏蔽干预措施是一个复杂的措施，由多个机构共同快速引入。我们确定了三个核心组成部分：对临床标准的协议；制定适合屏蔽的人员名单；以及屏蔽建议的沟通。此外，还有一个支持计划，根据需要向屏蔽人员提供食品包、经济支持和社会支持。预期的变化机制是人们将自我隔离，从而避免感染，屏蔽组的主要预期结果是死亡率降低。意外影响包括对心理健康和幸福感的负面影响。干预措施的细节在英国的不同地区略有不同，并在干预措施实施期间进行了微小的修订。
屏蔽是一种未经充分测试的策略，旨在通过让个人承担保护自己的责任来降低风险。该模型的原理、组成部分和结果（预期和非预期）将为评估屏蔽的影响提供信息，并帮助我们理解其效果和局限性。
