A longitudinal study of COVID-19 disclosure stigma and COVID-19 testing hesitancy in the United States

L Dayton; W Song; I Kaloustian; E L Eschliman; J C Strickland; C Latkin

doi:10.1016/j.puhe.2022.08.003

A longitudinal study of COVID-19 disclosure stigma and COVID-19 testing hesitancy in the United States

Public Health. 2022 Nov:212:14-21. doi: 10.1016/j.puhe.2022.08.003. Epub 2022 Aug 26.

Authors

L Dayton¹, W Song², I Kaloustian³, E L Eschliman⁴, J C Strickland⁵, C Latkin⁴

Affiliations

¹ Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA. Electronic address: Ldayton2@jhu.edu.
² Department of Applied Mathematics and Statistics, Johns Hopkins University, USA.
³ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA.
⁴ Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA.
⁵ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, USA.

Abstract

Objectives: This study examines the relationship between COVID-19 disclosure stigma and COVID-19 testing hesitancy and assesses their changes between November 2020 and 2021.

Study design: This was a longitudinal cohort.

Methods: A total of 355 participants completed four study waves between November 2020 and November 2021. Factor analyses and Cronbach's alpha assessed the factor structure and internal consistency of the COVID-19 Disclosure Stigma scale. Paired t-tests and McNemar's Chi-squared test assessed change between the study waves. Multivariable logistic regression models examined the relationship between COVID-19 disclosure stigma and testing hesitancy at four study waves.

Results: COVID-19 disclosure stigma declined significantly between the last study waves (P = 0.030). The greatest disclosure concern was reporting a positive test to close contacts (range: 19%-21%) followed by disclosure to friends (range: 10%-15%) and family (range: 4%-10%). Over the course of the four study waves, COVID-19 testing hesitancy when symptomatic ranged from 23% to 30%. Older age, female gender, and having received a COVID-19 vaccine were associated with decreased odds of testing hesitancy. Greater COVID-19 disclosure stigma and more conservative political ideology showed a consistent relationship with increased odds of COVID-19 testing hesitancy.

Conclusions: Study findings suggest that many people anticipate feeling stigmatized when disclosing positive test results, especially to close contacts. A substantial percentage of study participants reported hesitancy to be tested when symptomatic. This study identifies a need for interventions that normalize COVID-19 testing (e.g. engaging leaders with conservative followings), provide strategies for disclosing positive results, and allow anonymous notification of potential COVID-19 exposure.

Keywords: COVID-19 disclosure stigma; COVID-19 testing hesitancy; Coronavirus; Stigma.

MeSH terms

COVID-19 Testing
COVID-19 Vaccines
COVID-19* / diagnosis
Disclosure*
Female
Humans
Longitudinal Studies
United States / epidemiology

Substances

COVID-19 Vaccines

Grants and funding

R01 DA040488/DA/NIDA NIH HHS/United States