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

Zhang, J. C.; Christensen, K. L.; Leuchter, R. K.; Vangala, S.; Han, M.; Croymans, D. M.

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.