UK-REACH

The association of ethnicity and migration status with agenda for change pay band in National Health Service healthcare workers: Results from the United Kingdom Research study into Ethnicity and Coronavirus Disease 2019 (COVID-19) Outcomes in Healthcare workers (UK-REACH), Ji Soo Choi, Christopher A. Martin, Lucy Teece, Mayuri Gogoi, Irtiza Qureshi, Daniel Pan, Joshua Nazareth, Rebecca F. Baggaley, Luke Bryant, Padmasayee Papineni, Carol Woodhams, Katherine Woolf, and Manish Pareek, JRSM Open, Volume 16, Page 5, May 19, 2025 https://doi.org/10.1177/20542704251330157

The impact of long COVID on UK healthcare workers and their workplace: a qualitative study of healthcare workers with long COVID, their families, colleagues and managers, Amani Al-Oraibi, Carolyn Tarrant, Katherine Woolf, Laura B. Nellums & Manish Pareek, BMC Health Services Research, Volume 25, Page 519, April 9, 2025 https://doi.org/10.1186/s12913-025-12677-x

Global prevalence of long COVID and its most common symptoms among healthcare workers: a systematic review and meta-analysis, Amani Al-Oraibi, Katherine Woolf, Jatin Naidu, Laura B Nellums, Daniel Pan, Shirley Sze, Carolyn Tarrant, Christopher A Martin, Mayuri Gogoi, Joshua Nazareth, Pip Divall, Brendan Dempsey, Danielle Lamb, Manish Pareek, BMJ Public Health, Volume 3, Issue 1, Page e000269, April 18, 2025 10.1136/bmjph-2023-000269

Prevalence of and factors associated with long COVID among diverse healthcare workers in the UK: a cross-sectional analysis of a nationwide study (UK-REACH), Amani Al-Oraibi, Christopher A Martin, Katherine Woolf, Luke Bryant, Laura B Nellums, Carolyn Tarrant, Kamlesh Khunti, Manish Pareek, BMJ Open, Volume 15, Issue 1, Page e086578, Jan. 7, 2025 10.1136/bmjopen-2024-086578

Pay satisfaction and intentions to leave the NHS: a UK-based cohort study, Raman Mishra, Anna L. Guyatt, Asta Medisauskaitea, Christopher A. Martin, Asad Masood, Vishant Modhwadia, Luke Bryant, Holly Reilly, Srinivasa Vittal Katikireddi, Katherine Woolf, Manish Pareek, The Lancet Regional Health - Europe, Volume 0, https://doi.org/10.1016/j.lanepe.2025.101454

This study looks into the challenges faced by healthcare workers (HCWs) in the UK during the COVID-19 pandemic, particularly how these challenges were influenced by their background, such as ethnicity, gender, and job role. While previous research has highlighted how issues like lack of proper protective equipment (PPE), redeployment, and shortage of staff, can affect HCWs, this study goes further by looking at how these challenges can be experienced differently by HCWs from certain backgrounds. The researchers conducted interviews and focus groups with 164 HCWs from different backgrounds between December 2020 and July 2021. The analyses of the interviews and focus groups brought out three main challenges experienced by HCWs: disempowerment, disadvantage, and discrimination. For individual HCWs these experiences were shaped by the intersection (or meeting) of their unique social backgrounds, but also shows how inequalities within existing social, economic and political systems contributed to these challenges. The study introduces the concept of "intrasectionalism," which combines intersectionality (how different social identities overlap to create unique experiences) with an ‘ecosystem approach’ (how people interact with and are influenced by their environments e.g. family, workplace, local governance and social norms) to look at how discrimination, disempowerment and disadvantage exist and continue for certain groups. This approach helps explain why HCWs from certain backgrounds faced greater difficulties during the pandemic and highlights the need for solutions that address these complex, overlapping inequities.

Discrimination, disadvantage and disempowerment during COVID-19: a qualitative intrasectional analysis of the lived experiences of an ethnically diverse healthcare workforce in the United Kingdom, Irtiza Qureshi, Mayuri Gogoi, Amani Al-Oraibi, Fatimah Wobi, Jonathan Chaloner, Laura Gray, Anna L Guyatt, Osama Hassan, Laura B Nellums, Manish Pareek, UK-REACH Collaborative Group, International Journal for Equity in Health., https://doi.org/10.1186/s12939-024-02198-0

Corrigendum to “Persistent hesitancy for SARS-CoV-2 vaccines among healthcare workers in the United Kingdom: analysis of longitudinal data from the UK-REACH cohort study” [The Lancet Regional Health – Europe, Volume 13, February 2022, 100299], Christopher A. Martin, Katherine Woolf, Luke Bryant, Sue Carr, Laura J. Gray, Amit Gupta, Anna L. Guyatt, Catherine John, Carl Melbourne, I. Chris McManus, Joshua Nazareth, Laura B. Nellums, Martin D. Tobin, Daniel Pan, Kamlesh Khunti, Manish Pareek, The Lancet Regional Health - Europe, Volume 48, Page 101148, Nov. 21, 2024 10.1016/j.lanepe.2024.101148

Defining within-host SARS-CoV-2 RNA viral load kinetics during acute COVID-19 infection within different respiratory compartments and their respective associations with host infectiousness: a protocol for a systematic review and meta-analysis, Daniel Pan, Christopher A Martin, Joshua Nazareth, Shirley Sze, Amani Al-Oraibi, Mayuri Gogoi, Natalia Grolmusova, Pip Divall, Jonathan Decker, Eve Fletcher, Caroline Williams, James Hay, Rebecca F. Baggaley, Anne L Wyllie, Iain Stephenson, Erol Gaillard, Laura B Nellums, Tristan William Clark, Jonathan Nguyen Van-Tam, Benjamin J Cowling, T. Déirdre Hollingsworth, Laura Gray, Michael Barer, Manish Pareek, BMJ Open, Volume 14, Issue 1, Page e085127, Dec. 2, 2024 10.1136/bmjopen-2024-085127

Coping strategies used by migrant healthcare workers to support their mental health during COVID-19 in the United Kingdom: a qualitative analysis, Joy O. Agbonmwandolor, Jonathan Chaloner, Mayuri Gogoi, Irtiza Qureshi, Amani Al-Oraibi, Winifred Ekezie, Holly Reilly, Fatimah Wobi, Laura B. Nellums, Manish Pareek, European Journal of Psychotraumatology, Volume 24, 10.1080/20008066.2024.2415747

Factors associated with attrition from the UK healthcare workforce since the COVID-19 pandemic: results from a nationwide survey study, Christopher A. Martin, Asta Medisauskaite, Anna L. Guyatt, Raman Mishra, Srinivasa Vittal Katikireddi, Katherine Woolf, Manish Pareek, Manish Pareek, Katherine Woolf, Carol Woodhams, Sorin Krammer, Carol Rivas, Anna L. Guyatt, Asta Medisauskaite, Srinivasa Vittal Katikireddi, Padmasayee Papineni, Susie Lagrata, Mehrunisha Suleman, Asad Masood, Luke Bryant, The Lancet Regional Health - Europe, Volume 47, Page 101133, Nov. 27, 2024 10.1016/j.lanepe.2024.101133

Redeployment and Changes in Working Patterns of Healthcare Workers during COVID-19 in the UK: A Qualitative Study, Zainab Zuzer Lal, Mayuri Gogoi, Irtiza Qureshi, Amani Al-Oraibi, Jonathan Chaloner, Padmasayee Papineni, Susie Lagrata, Laura B Nellums, Christopher A. Martin, Katherine Woolf, Manish Pareek, Pre-Print, 10.21203/rs.3.rs-4867437/v1

Redeployment experiences of healthcare workers in the UK during COVID-19: a cross-sectional analysis from the nationwide UK-REACH study, Zainab Zuzer Lal, Christopher A. Martin, Mayuri Gogoi, Irtiza Qureshi, Luke Bryant, Padmasayee Papineni, Susie Lagrata, Laura B Nellums, Amani Al-Oraibi, Jonathon Chaloner, Katherine Woolf, and Manish Pareek, JRSM Open, Volume 15, Issue 9, https://doi.org/10.1177/20542704241290721

Immunogenicity of concomitant SARS-CoV-2 and influenza vaccination in UK healthcare workers: a prospective longitudinal observational study, Joshua Nazareth, Christopher A. Martin, Daniel Pan, Ian G. Barr, Sheena G. Sullivan, Heidi Peck, Neyme Veli, Mrinal Das, Luke Bryant, Nisha George, Marjan Gohar, Laura J. Gray, Lucy Teece, Denny Vail, Val Renals, Aleesha Karia, Paul Renals, Paul Moss, Andrea Tattersall, Ashley D. Otter, Pranab Haldar, Andrea Cooper, Iain Stephenson, Martin J. Wiselka, Julian W. Tang, Laura Nellums, Manish Pareek, The Lancet Regional Health - Europe, Volume 44, Page 101022, Aug. 13, 2024 10.1016/j.lanepe.2024.101022

This commentary acknowledges how pressures such as high workload, stretched resources, and financial stress result in healthcare workers experiencing high mental health conditions, high suicide rates, staff absences, and high vacancy rates for certain healthcare professions. We present an analysis of healthcare workers' mental health and well-being needs across the United Kingdom. We recommend that healthcare organisations consider the specific circumstances of these staff and develop strategies to counter the negative impact of these factors and help safeguard the mental health of their staff. Recommendations include strategies suggested by healthcare workers themselves.

Caring for Those Who Take Care of Others: Developing Systemic and Sustainable Mental Health Support for the Diverse Healthcare Workforce in the United Kingdom, Irtiza Qureshi, Jonathan Chaloner, Mayuri Gogoi, Amani Al-Oraibi, Fatimah Wobi, Holly Reilly, Asta Medisauskaite, Christopher A. Martin, Patricia Irizar, Padmasayee Papineni, Susie Lagrata, Joy Agbonmwandolor, Manish Pareek, Laura Nellums, International Journal of Environmental Research and Public Health, Volume 20, Issue 4, Page 3242, Feb. 13, 2023 https://doi.org/10.3390/ijerph20043242

The UK’s National Health Service (NHS) is facing a big staffing crisis, with nearly 1 in 10 jobs unfilled. A 2022 report by the World Health Organization showed the UK has the fewest doctors, nurses, midwives, and dentists per 10,000 people in Western Europe. This shortage affects patient care, leading to worse outcomes and lower satisfaction, and it’s expensive to keep replacing staff. Currently, the NHS is trying to fix the problem by recruiting more workers, including from other countries. However, the World Health Organization predicts a global shortage of 10 million healthcare workers by 2030, especially in poorer countries. There’s also talk about training more staff locally, but the government says this would be costly, and there’s uncertainty about whether universities and the NHS can provide good training. To solve the issue, it’s not just about hiring more staff; it’s important to keep the current staff from leaving and improve retention. Finding ways to make sure healthcare workers stay in their jobs will help reduce pressure and improve care for patients.

Retention of ethnic minority staff is critical to resolving the NHS workforce crisis, Katherine Woolf, Padmasayee Papineni, Susie Lagrata, Manish Pareek, BMJ Open, Volume 380, Page 541, March 10, 2023 https://doi.org/10.1136/bmj.p541

This study aimed to compare immune responses to the COVID-19 vaccine between different ethnic groups among healthcare workers (HCWs) in the UK. Researchers gathered blood samples from vaccinated HCWs in Leicester who had not previously been infected with the virus. They measured immune responses, focusing on antibody levels and T cell activity, to see if there were differences between South Asian, Black, and White HCWs. The results showed that South Asian HCWs had stronger immune responses than White HCWs. Specifically, South Asians had higher levels of neutralising antibodies and stronger T cell responses to the vaccine. These differences were most noticeable soon after the second vaccine dose. In particular, South Asian HCWs had significantly higher antibody levels compared to White HCWs. The study suggests that ethnicity might influence how the immune system responds to the COVID-19 vaccine. However, more research is needed to understand why these differences occur, if they continue after more vaccinations or virus exposure, and how they might affect the overall effectiveness of the vaccine. These findings could help improve vaccine strategies for different ethnic groups in the future.

Ethnic differences in cellular and humoral immune responses to SARS-CoV-2 vaccination in UK healthcare workers: a cross-sectional analysis, Christopher A. Martin, Joshua Nazareth, Amar Jarkhi, Daniel Pan, Mrinal Das, Nicola Logan, Sam Scott, Luke Bryant, Neha Abeywickrama, Oluwatobi Adeoye, Aleem Ahmed, Aqua Asif, Srini Bandi, Nisha George, Marjan Gohar, Laura J. Gray, Ross Kaszuba, Jitendra Mangwani, Marianne Martin, Arumugam Moorthy, Valerie Renals, Lucy Teece, Denny Vail, Kamlesh Khunti, Paul Moss, Andrea Tattersall, Bassam Hallis, Ashley D. Otter, Cathy Rowe, Brian J. Willett, Pranab Haldar, Andrea Cooper, Manish Pareek, eClinicalMedicine, Volume 58, Page 101926, April 4, 2023 https://doi.org/10.1016/j.eclinm.2023.101926

The COVID-19 pandemic has deeply affected people’s lives in the UK, with over 23 million infections and nearly 185,000 deaths. This study explored how different people experienced the pandemic and how it impacted their quality of life (QoL). Researchers conducted interviews with 18 diverse participants from various ethnic backgrounds, genders, and employment situations. Five main areas were identified where COVID-19 had an effect: financial and economic struggles, physical health, social life, mental health, and personal fulfilment. The study found that people in low-paid or insecure jobs suffered the most economically. Others who were already vulnerable, like those experiencing violence, mental or physical illness, or living alone, were hit harder in terms of social and mental health. The research highlighted that the pandemic’s effects were not the same for everyone. People who already faced social, economic, and health inequalities before the pandemic felt its impact more severely. The findings suggest that plans for pandemic recovery need to address these existing inequalities to make sure vulnerable groups are supported better.

One virus, many lives: a qualitative study of lived experiences and quality of life of adults from diverse backgrounds living in the UK during the COVID-19 pandemic, Mayuri Gogoi, Jonathan Chaloner, Irtiza Qureshi, Fatimah Wobi, Amani Al-Oraibi, Heather Wilson, Mehrunisha Suleman, Laura Nellums, Manish Pareek, BMJ Open, Volume 13, Issue 3, Page e067569, March 8, 2023 10.1136/bmjopen-2022-067569

Involving patients and the public in research about long COVID is crucial for understanding how it affects people’s lives and improving the design of studies. This involvement should include diverse groups, such as ethnic minorities and people with disabilities, to ensure the research reflects the wider population. For example, people with long COVID helped create the Symptom Burden Questionnaire in some UK studies. While researchers have made efforts to involve different people, healthcare workers are often left out, even though they were on the front lines of the pandemic and at higher risk of infection and long COVID. In our study, we worked with healthcare workers, particularly those from ethnic minority backgrounds, to explore the long-term effects of COVID-19 on NHS staff. Healthcare workers not only face a higher risk of getting long COVID but also deal with challenges beyond their physical symptoms. These include unclear workplace policies on sick leave and support, especially as the NHS struggles with staff shortages and strikes. Addressing these issues is key to supporting healthcare workers who have been impacted by long COVID.

Healthcare workers must be included in long covid research in the UK, Amani Al-Oraibi, Katherine Woolf, Shazia Fatimah, Manish Pareek, The BMJ, Volume 382, Page 1721, July 26, 2023 https://doi.org/10.1136/bmj.p1721

Coverage, completion and outcomes of COVID-19 risk assessments in a multi-ethnic nationwide cohort of UK healthcare workers: a cross-sectional analysis from the UK-REACH Study, Christopher A Martin, Katherine Woolf, Luke Bryant, Charles Goss, Mayuri Gogoi, Susie Lagrata, Padmasayee Papineni, Irtiza Qureshi, Fatimah Wobi, Laura Nellums, Kamlesh Khunti, Manish Pareek, Occupational and Environmental Medicine, Volume 80, Issue 7, Page 399-406, May 23, 2023 https://dx.doi.org/10.1136/oemed-2022-108700

The NHS is facing a major crisis as increasing numbers of healthcare workers leave their jobs, worsening patient care. A 2022 report highlighted significant shortages of doctors, nurses, and midwives. Data shows that since 2021, staff departures have varied by region, role, and other factors, but the reasons behind these exits are unclear. A survey found that over half of NHS workers were considering job changes, but it’s unclear why or what could make them stay. To address this, a study investigated whether NHS workers were thinking of quitting due to feeling undervalued by the government, the public, or their employer and whether they experienced discrimination at work. The study surveyed healthcare workers between October and December 2021, finding that nearly half had considered or acted on plans to leave their jobs due to the COVID-19 pandemic. Women, older workers, and those from mixed ethnic backgrounds were more likely to leave, while healthcare scientists were less likely to do so. The findings suggest that feeling undervalued and experiencing discrimination might be driving this trend, and more needs to be done to improve worker retention in the NHS.

Discrimination, feeling undervalued, and health-care workforce attrition: an analysis from the UK-REACH study, Christopher A. Martin, Asta Medisauskaite, Mayuri Gogoi, Lucy Teece, Joshua Nazareth, Daniel Pan, Sue Carr, Kamlesh Khunti, Laura B. Nellums, Katherine Woolf, Manish Pareek, The Lancet, Volume 402, Issue 1, Page 845-848, Aug. 18, 2023 https://doi.org/10.1016/S0140-6736(23)01365-X

Researchers have used "intersectionality" to study different forms of oppression people face based on their characteristics, like race, gender, or class. Building on this, a new idea called "intrasectionalism" looks at how marginalisation happens at different levels—personal (micro), community (meso), and societal (macro). This approach helps us understand how oppression can overlap and worsen at each level. The paper introduces intrasectionalism as a new framework for research and calls for more work in this area. By using this concept, researchers can have better tools to study and understand social inequalities, particularly in health. The goal is to help researchers make more detailed and thoughtful analyses that lead to greater fairness and justice in society.

Contextualising Intersectionalism at Ecosystemic Levels: Introducing ‘Intrasectionalism’ as a Conceptual Framework, Irtiza Qureshi, Laura B Nellums, Mayuri Gogoi, Amani Al-Oraibi, Jonathan Chaloner, Holly Reilly, Manish Pareek, UK-REACH Collaborative Group, Social Science Research Network, https://dx.doi.org/10.2139/ssrn.4309833

This study looks at how financial worries affect depression in UK healthcare workers (HCWs), especially with the current cost of living crisis and ongoing issues like strikes and staff shortages in the NHS. Researchers used data from surveys to examine if financial concerns from late 2020 to early 2021 were linked to depression in 2022. Out of 3,521 HCWs studied, those with financial concerns were more likely to develop depression later on. Financial worries grew for nearly 44% of HCWs, while only 9% saw their worries decrease. Nurses, midwives, and other similar roles were twice as likely to have financial concerns compared to doctors. The study’s findings are worrying because financial stress is on the rise and could lead to more depression among HCWs. This could also impact staff absences and make it harder to keep workers in the NHS. The authors suggest that policymakers should take steps to ease these financial pressures to help improve the well-being of HCWs and prevent further problems in the NHS workforce.

Investigating the impact of financial concerns on symptoms of depression in UK healthcare workers: data from the UK-REACH nationwide cohort study, Martin McBride, Christopher A. Martin, Lucy Teece, Patricia Irizar, Megan Batson, Susie Lagrata, Padmasayee Papineni, Joshua Nazareth, Daniel Pan, Alison Leary, Katherine Woolf, Manish Pareek, the UK-REACH Study Collaborative Group, British Journal of Psychology Open, https://doi.org/10.1192/bjo.2023.520

During the COVID-19 pandemic, pregnant women were seen as particularly vulnerable to the virus. To protect both patients and the NHS, strict infection control rules were put in place in the UK. This study aimed to explore how these rules affected maternal and reproductive health services by gathering the experiences of healthcare workers (HCWs) caring for pregnant patients. The study involved 44 HCWs from the UK-REACH project, who were interviewed through focus groups and individual discussions. The interviews were analysed to identify key themes. Three main issues emerged. First, infection control measures led to many appointments being cancelled or delayed. Telemedicine was widely used but didn’t work well for patients from minority ethnic groups. Second, staff shortages and redeployments meant fewer consultations and scans were available. Finally, both staff and patients struggled to access timely and reliable information about the virus and vaccination. The study highlights how a global health crisis can harm maternal and reproductive services, reducing the quality of care. It calls for better preparation for future health crises, including policies tailored to specific needs, dealing with surgical backlogs early, and improving how vaccine information is shared.

A qualitative study exploring healthcare workers’ lived experiences of the impacts of COVID-19 policies and guidelines on maternal and reproductive healthcare services in the United Kingdom, Jonathan Chaloner, Irtiza Qureshi, Mayuri Gogoi, Winfred Ekezie, Amani Al-Oraibi, Fatimah Wobi, Joy Oghogho Agbonmwandolor, Laura B Nellums, Manish Pareek, European Journal of Midwifery, https://doi.org/10.18332/ejm/171802

This paper explored how long-term health conditions affect healthcare workers (HCWs) in the UK, focusing on differences based on ethnicity and migration status. Researchers analysed data from 12,100 HCWs, with an average age of 45. Of these, 27% were born overseas, and 30% belonged to non-White ethnic groups. The most common health issues reported were anxiety, asthma, depression, hypertension, and diabetes. The paper found that mental health conditions like anxiety were more common in UK-born HCWs across all ethnicities compared to those born overseas. Conversely, diabetes and hypertension were more prevalent among Asian and Black HCWs than their White UK-born counterparts. Interestingly, overseas-born HCWs had lower chances of having multiple long-term conditions (MLTCs) than UK-born White HCWs, but this difference decreased the longer they lived in the UK. Overall, the paper highlights that the likelihood of HCWs having long-term health conditions varies by ethnicity and whether they were born in the UK or overseas. The findings suggest that future research and healthcare interventions should be tailored to address the specific health needs of HCWs from different ethnic and migrant backgrounds to help reduce the burden of long-term health issues.

Association between ethnicity and migration status with the prevalence of single and multiple long-term conditions in UK healthcare workers, Christopher A. Martin, Rebecca Baggaley, Amani Al-Oraibi, Manish Pareek, BMC Medicine, https://doi.org/10.1186/s12916-023-03109-w

Ethnic differences in cellular and humoral immune responses to SARS-CoV-2 vaccination in UK healthcare workers: a cross-sectional analysis, Christopher A. Martin, Joshua Nazareth, Amar Jarkhi, Daniel Pan, Mrinal Das, Nicola Logan, Sam Scott, Luke Bryant, Neha Abeywickrama, Oluwatobi Adeoye, Aleem Ahmed, Aqua Asif, Srini Bandi, Nisha George, Marjan Gohar, Laura J. Gray, Ross Kaszuba, Jitendra Mangwani, Marianne Martin, Arumugam Moorthy, Valerie Renals, Lucy Teece, Denny Vail, Kamlesh Khunti, Paul Moss, Andrea Tattersall, Bassam Hallis, Ashley D. Otter, Cathy Rowe, Brian J. Willett, Pranab Haldar, Andrea Cooper, Manish Pareek, eClinicalMedicine, Volume 58, Page 101926, April 4, 2023 10.1016/j.eclinm.2023.101926

Healthcare workers are at greater risk of COVID-19 than the general population. Effective use of personal protective equipment (PPE), which includes the masks and gowns worn when attending to COVID-19 patients, reduces this risk. We surveyed over 12,000 healthcare workers to ask them about their experience of access to PPE both during the first UK national lockdown (March 2020) and at the time of the questionnaire response (December 2020 – March 2021). 35.2% reported access to PPE at all times during lockdown. This rose to 83.9% at the time of the questionnaire response. During UK national lockdown, these factors were associated with a decreased probability of having access to PPE at all times: - Being from an Asian ethnic group (compared to White) - Working in an allied health professional or dental role (compared to medical roles) - Seeing a higher number of COVID-19 patients - Indicating a lack of trust in one’s employing organisation The following factors were associated with an increased probability of having access to PPE at all times: - Being older - Working in intensive care Although the proportion of those reporting access to PPE at all times had improved by the time of the questionnaire response, there was not much change in the factors associated with an increased or decreased probability of access to PPE.

Access to personal protective equipment in healthcare workers during the COVID-19 pandemic in the United Kingdom: results from a nationwide cohort study (UK-REACH), Christopher A Martin, Daniel Pan, Joshua Nazareth, Avinash Aujayeb, Luke Bryant, Sue Carr, Laura J Gray, Bindu Gregary, Amit Gupta, Anna Louise Guyatt, Alan Gopal, Thomas Hine, Catherine John, Ian Christopher McManus, Carl Melbourne, Laura B Nellums, Rubina Reza, Sandra Simpson, Martin D Tobin, Katherine Woolf, Stephen Zingwe, Kamlesh Khunti, Manish Pareek, the UK-REACH Study Collaborative Group, BMC Health Services Research, https://doi.org/10.1186/s12913-022-08202-z

In this paper we present findings from the UK-REACH qualitative study which was conducted among healthcare workers (HCWs) from diverse ethnicities, job roles and regions in the UK. We explored attitudes and perceptions about the COVID-19 vaccine among HCWs, using interviews and focus groups. Our data show that HCWs' attitudes towards the COVID-19 vaccine are varied and range from actively accepting the vaccine to actively refusing it. We found that knowledge of vaccines, assessment of risk, acceptance of other vaccines, influences from family and friends, and thoughts about the future are factors which help in the acceptance of COVID-19 vaccine among our participants. Simultaneously, we also found that issues with (mis)trust, inadequate communication and bias in delivery and access can hamper vaccine acceptance. Our data also show HCWs to be divided in their opinion about mandatory/compulsory COVID-19 vaccination, and some believe that making vaccination binding could further bring down trust and victimise those who have valid concerns about the vaccine. We, therefore, recommend trust-building, designing inclusive and accessible information, and addressing inequalities for improving vaccine acceptance among HCWs.

“The vaccination is positive; I don’t think it’s the panacea”: A qualitative study on COVID-19 vaccine attitudes among ethnically diverse healthcare workers in the United Kingdom, Mayuri Gogoi, Fatimah Wobi, Irtiza Qureshi, Amani Al-Oraibi, Osama Hassan, Laura B Nellums, Manish Pareek, PLoSONE, https://doi.org/10.1371/journal.pone.0273687

In previous work from UK-REACH, we determined the factors that were associated with hesitancy for the initial doses of the COVID-19 vaccine. In this analysis, we investigated which factors are associated with remaining hesitant about receiving a vaccine over time. To do this we looked at healthcare workers who indicated that they were hesitant about receiving the vaccine in the baseline UK-REACH questionnaire and had not yet had both vaccine doses. We then followed these people up to see if they were still hesitant about receiving a second dose of vaccine at the time of the second questionnaire (April – June 2021). 990 healthcare workers were included in the analysis, of whom 275 (27.7%) remained hesitant. Persistent hesitancy was more likely in younger healthcare workers and those in nursing, allied health professional and dental roles (compared to those in medical roles). Those who trusted vaccine information from official sources (the Government, NHS, WHO) were less likely to remain hesitant, as were those who indicated they believed vaccines were important for protecting themselves, their families and their patients. Those who had received information advocating against vaccination from their family were more likely to remain hesitant. These findings should directly inform interventions aimed at improving vaccine uptake among healthcare workers and the wider community.

Persistent hesitancy for SARS-CoV-2 vaccines among healthcare workers in the United Kingdom: analysis of longitudinal data from the UK-REACH cohort study, Christopher A. Martin, Katherine Woolf, Luke Bryant, Sue Carr, Laura J. Gray, Amit Gupta, Anna L. Guyatt, Catherine John, Carl Melbourne, I. Chris McManus, Joshua Nazareth, Laura B. Nellums, Martin D. Tobin, Daniel Pan, Kamlesh Khunti, Manish Pareek, The Lancet Regional Health - Europe, Volume 13, Page 100299, Feb. 1, 2022 https://doi.org/10.1016/j.lanepe.2021.100299

Healthcare workers (HCWs), particularly those from ethnic minority groups, be at higher risk of COVID-19 than the general population. However, there is not much evidence relating to the home, work and lifestyle factors that might influence COVID-19 risk in ethnic minority healthcare workers. From December 2020 to March 2021, we surveyed 10,772 healthcare workers working during the first UK national lockdown in March 2020. 23.2% reported the previous COVID-19. The following factors were associated with a higher risk of COVID-19: - Seeing more COVID-19 patients - Working in a nursing role (compared to working in a medical role) - Reporting a lack of access to personal protective equipment (PPE) - Working in an ambulance or hospital inpatient setting Working in intensive care was associated with a lower risk of COVID-19. Black healthcare workers were at higher risk of COVID-19 than White healthcare workers. After taking home, work and lifestyle factors into account, the COVID-19 risk between ethnic groups was similar. This suggests that these same home, work and lifestyle factors are likely to be involved in the different COVID-19 risks seen by ethnic groups. Our findings should inform policies, including targeted vaccination strategies and risk assessments aimed at protecting healthcare workers in future waves of the COVID-19 pandemic.

Risk factors associated with SARS-CoV-2 infection in a multiethnic cohort of United Kingdom healthcare workers (UK-REACH): A cross-sectional analysis, Christopher A. Martin, Daniel Pan, Carl Melbourne, Lucy Teece, Avinash Aujayeb, Rebecca F. Baggaley, Luke Bryant, Sue Carr, Bindu Gregary, Amit Gupta, Anna L. Guyatt, Catherine John, I Chris McManus, Joshua Nazareth, Laura B. Nellums, Rubina Reza, Sandra Simpson, Martin D. Tobin, Katherine Woolf, Stephen Zingwe, Kamlesh Khunti, Keith R. Abrams, Laura J. Gray, Manish Pareek, PLOS Medicine, https://doi.org/10.1371/journal.pmed.1004015

This paper presents findings from Work Package 3, the ethical and legal work package of UK-REACH (“The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers”). We interviewed 22 key opinion leaders in healthcare and health research from across the UK to better understand the legal, ethical, and social acceptability issues associated with the linkage of healthcare workers’ registration data and healthcare data. Participants told us that a significant issue across all stages of Big Data research studies in public health such as UK-REACH are drivers of mistrust – of the research itself, research staff and funders, and broader concerns of mistrust within participant communities, particularly in the context of COVID-19 and those situated in more marginalised community settings. However, despite the challenges, participants also identified ways in which legally compliant and ethically informed approaches to research can be crafted to address mistrust and establish confidence in Big Data public health research. Overall, our research indicates that a “Big Data Ethics by Design” approach can help assure 1) that meaningful engagement is taking place and that challenges are adequately addressed, and 2) that any new challenges that arise during the research can be rapidly and properly considered to ensure any harms are identified and minimised where necessary. Our findings indicate such an approach, in turn, will help drive better scientific breakthroughs that translate into medical innovations and effective public health interventions, which benefit the publics studied.

“Data makes the story come to life.” Understanding the ethical and legal implications of Big Data research involving ethnic minority healthcare workers: a qualitative study, Edward S. Dove, Ruby Reed-Berendt, Manish Pareek, BMC Medical Ethics, https://doi.org/10.31235/osf.io/wdk9b

This review aims to estimate the prevalence and symptoms of long COVID-19 in healthcare workers (HCWs) who have survived the acute phase of COVID-19 globally and investigate potential differences by country, age, sex, ethnicity, vaccination status, and occupation. Since HCWs face a higher risk of getting COVID-19, it is likely that many of them will experience long COVID. The systematic review will look at data from all over the world to estimate how many HCWs are affected by long COVID and what symptoms they experience through a meta-analysis. The review will also investigate if there are any differences in the prevalence and symptoms of long COVID among HCWs based on factors such as age, sex, ethnicity, vaccination status, and occupation. The findings will be shared with healthcare professionals and researchers to help them better understand and manage long COVID-19 in HCWs.

Prevalence of long COVID-19 among healthcare workers: a systematic review and meta-analysis protocol, Amani Al-Oraibi, Jatin Sridhar Naidu, Aasiya Chaka, Katherine Woolf, Laura B Nellums, Carolyn Tarrant, Daniel Pan, Shirley Sze, Christopher A Martin, Mayuri Gogoi, Joshua Nazareth, Manish Pareek, BMJ Open, Volume 12, Issue 1, Page e065234, Dec. 6, 2022 https://doi.org/10.1136/bmjopen-2022-065234

This paper presents healthcare workers' perceptions of risks and experiences with risk management whilst working throughout the COVID-19 pandemic. Five broad themes emerged from our discussions with HCWs. First, ethnic minority HCWs spoke about specific risks and vulnerabilities they faced in relation to their ethnicity. Second, participants’ experience of risk assessments at work varied; some expressed satisfaction while many critiqued it as a “tick-box” exercise. Third, most participants shared about risks related to shortages, ambiguity in guidance, and unequal distribution of Personal Protective Equipment (PPE), particularly during the start of the pandemic. Fourth, participants reported risks resulting from understaffing and inappropriate redeployment. Finally, HCWs shared the strategies which they had personally employed to protect themselves, their families, and the public. These findings have significance in understanding staff safety, well-being, and workforce retention in multi-ethnic staff groups and also highlight the need for more robust, inclusive, and equitable approaches to protect HCWs going forward.

Healthcare Workers From Diverse Ethnicities and Their Perceptions of Risk and Experiences of Risk Management During the COVID-19 Pandemic: Qualitative Insights From the United Kingdom-REACH Study, Irtiza Qureshi, Mayuri Gogoi, Fatimah Wobi, Jonathan Chaloner, Amani Al-Oraibi, Osama Hassan, Daniel Pan, Laura B. Nellums and Manish Pareek, Frontiers in Medicine, https://doi.org/10.3389/fmed.2022.930904

This commentary acknowledges how pressures such as high workload, stretched resources, and financial stress are resulting in healthcare workers experiencing high rates of mental health conditions, high suicide rates, staff absences, and high vacancy rates for certain healthcare professions. We present an analysis of healthcare workers' mental health and well-being needs across the United Kingdom. We recommend that healthcare organisations should consider the specific circumstances of these staff and develop strategies to counter the negative impact of these factors and help safeguard the mental health of their staff. Recommendations include strategies suggested by healthcare workers themselves.

Factors influencing the mental health of an ethnically diverse healthcare workforce during COVID-19: a qualitative study in the United Kingdom, Irtiza Qureshi, Mayuri Gogoi, Amani Al-Oraibi, Fatimah Wobi, Jonathan Chaloner, Laura Gray, Anna L Guyatt, Osama Hassan, Laura B Nellums, Manish Pareek, European Journal of Psychotraumatology, Volume 13, Issue 2, https://doi.org/10.1080/20008066.2022.2105577

This article highlights the importance of understanding how people from minority ethnic backgrounds in the UK were disproportionately affected by COVID-19. While the government has recognised this, there are still major issues in how data is collected and used to fully understand the problem. Reports show that people from minority ethnic groups, especially healthcare workers, faced higher risks due to factors like frontline work and limited access to protective gear. However, there’s a lack of clear recommendations on how to gather and analyse data to explore the impact of things like job risks, ethnicity, and other social factors together. The report stresses that ethnicity, occupation, gender, and other characteristics are often looked at separately, which overlooks how they combine to make certain groups more vulnerable. Early in the pandemic, data on minority ethnic healthcare workers had to rely on media reports, showing how little information was available. Although more research has been done since then, there still isn’t an easy way to collect and analyse data on how these factors overlap. The article calls for better systems to gather and study data on health inequalities to help the government respond more quickly and effectively in future pandemics.

Intersectionality and Developing Evidence-Based Policy, Irtiza Qureshi, Mayuri Gogoi, Amani Al-Oraibi, Fatimah Wobi, Daniel Pan, Christopher A Martin, Jonathan Chaloner, Katherine Woolf, Manish Pareek, Laura B Nellums, The Lancet, Volume 399, Issue 1, Page 355-356, Jan. 22, 2022 https://doi.org/10.1016/S0140-6736(21)02801-4

The COVID-19 pandemic has caused major disruptions worldwide, but vaccines have helped reduce hospitalisations and deaths. Healthcare workers (HCWs) are at higher risk of COVID-19, making them a priority for vaccination to protect both themselves and vulnerable patients. However, as new virus variants like Omicron emerge and immunity decreases over time, COVID-19 continues to spread even in vaccinated people. In response, the UK government has offered booster doses to HCWs and vulnerable groups, with plans for annual vaccinations to prevent winter COVID-19 surges. Despite these efforts, some HCWs are hesitant about getting vaccinated. Previous research found that 23% of UK HCWs were unsure about receiving the initial vaccine doses, with younger people, women, and Black ethnic groups showing more hesitation. A lack of trust in official vaccine information sources was linked to this hesitancy. A US study showed similar patterns of reluctance for yearly boosters, but no studies have explored this in UK HCWs. To address this, a study was conducted to measure how many UK HCWs are hesitant about receiving regular COVID-19 vaccinations. The study also examined how factors like age, ethnicity, occupation, and trust in vaccine information affect this hesitancy, aiming to improve vaccine uptake among healthcare workers.

Hesitancy for receiving regular SARS-CoV-2 vaccination in UK healthcare workers: a cross-sectional analysis from the UK-REACH study, Neyme Veli, Christopher A. Martin, Katherine Woolf, Joshua Nazareth, Daniel Pan, Amani Al-Oraibi, Rebecca F. Baggaley, Luke Bryant, Laura B. Nellums, Laura J. Gray, Kamlesh Khunti, Manish Pareek & The UK-REACH Study Collaborative Group, BMC Medicine, Volume 386, Issue 20, https://doi.org/10.1186/s12916-022-02588-7

The COVID-19 pandemic has severely impacted the world, with over 110.7 million cases and 2.4 million deaths globally. In the UK, certain groups, especially ethnic minorities and those in poorer areas, have been hit harder by the virus. Factors like age, gender, deprivation, and pre-existing health conditions are known to worsen COVID-19 outcomes. However, researchers are still trying to understand why ethnic minorities are more affected, considering complex factors like socioeconomic status, cultural differences, and health conditions. Healthcare workers (HCWs) face higher risks of exposure to COVID-19 due to their work. Alarmingly, HCWs from ethnic minorities seem to have even worse outcomes. Although they make up less than 20% of the NHS workforce, they account for a significant portion of healthcare worker deaths during the pandemic. Unfortunately, the data on how ethnicity affects COVID-19 outcomes in HCWs is poor, making it hard to fully understand the risks. The UK-REACH study aims to address this by exploring the relationship between ethnicity and COVID-19 outcomes in healthcare workers. It will use a large database to investigate how factors like diagnosis, hospitalisation, and death vary across different ethnic groups, aiming to protect vulnerable healthcare workers and improve understanding of these risks.

Cohort Profile: The United Kingdom Research study into Ethnicity and COVID-19 outcomes in Healthcare workers (UK-REACH), Luke Bryant, Robert C Free, Katherine Woolf, Carl Melbourne, Anna L Guyatt, Catherine John, Amit Gupta, Laura J Gray, Laura Nellums, Christopher A Martin, I Chris McManus, Claire Garwood, Vishant Modhawdia, Sue Carr, Louise V Wain, Martin D Tobin, Kamlesh Khunti, Ibrahim Akubakar, Manish Pareek, Manish Pareek, Laura Gray, Laura Nellums, Anna L Guyatt, Catherine John, I Chris McManus, Katherine Woolf, Ibrahim Akubakar, Amit Gupta, Keith R Abrams, Martin D Tobin, Louise Wain, Sue Carr, Edward Dove, Kamlesh Khunti, David Ford, Robert Free, the UK-REACH Collaborative Group+, International Journal of Epidemiology, Volume 52, Issue 1, Page e38-e45, Aug. 27, 2022 https://doi.org/10.1093/ije/dyac171

Many countries in Europe and elsewhere have recently made vaccination against COVID-19 compulsory. In England also, compulsory (mandatory) vaccination has been announced for those working in health and social care. However, healthcare worker's (HCWs) views on compulsory COVID-19 vaccination are not well known. We analysed the answers given by survey participants to a free-response question, “What could society do if people don't get vaccinated against COVID-19?” that was asked in the second UK-REACH questionnaire. Of 5633 survey participants, 3235 answered this question. The answers were broadly grouped into two categories: those who favour compulsory vaccination and those who do not. Our analysis shows that only one in six (18%) HCWs favoured mandatory vaccination, whereas 82% favoured other options, the most common (32%) being, ‘Educate, increase access or incentivise’. Further statistical analysis found that older HCWs, HCWs vaccinated against influenza and with more positive vaccination attitudes generally were more likely to favour mandatory vaccination. Simultaneously we found that female HCWs, Black HCWs, those hesitant about COVID-19 vaccination, those working in an Allied Health Professional role, or who trusted their organisation were less likely to favour compulsory vaccination. We, therefore, conclude that building trust and, educating and supporting HCWs who are hesitant about vaccination may be more acceptable, effective and equitable.

Healthcare workers’ views on mandatory SARS-CoV-2 vaccination in the UK: A cross-sectional, mixed-methods analysis from the UK-REACH study, Katherine Woolf, Mayuri Gogoi, Christopher A. Martin, Padmasayee Papineni, Susie Lagrata, Laura B. Nellums, I.Chris McManus, Anna L. Guyatt, Carl Melbourne, Luke Bryant, Amit Gupta, Catherine John, Sue Carr, Martin D. Tobin, Sandra Simpson, Bindu Gregary, Avinash Aujayeb, Stephen Zingwe, Rubina Reza, Laura J. Gray, Kamlesh Khunti, Manish Pareek, eClinicalMedicine, Volume 46, Page 101346, March 15, 2022 https://doi.org/10.1016/j.eclinm.2022.101346

In the UK, over 21.4 million people had been confirmed with COVID-19 by April 2022, and many are still dealing with long-term symptoms known as long-term COVID. Around 1.7 million people have experienced symptoms lasting longer than four weeks, with some having them for over a year. Healthcare workers, especially from ethnic minority backgrounds, are at higher risk of poor health outcomes, including long-term COVID, due to the pressures they face, such as long hours, staff shortages, and limited protective equipment. Despite the growing focus on long COVID, most research has concentrated on the general population, leaving a critical gap in understanding how it affects healthcare workers and ethnic minorities. These groups are essential to the NHS, making up a large percentage of its workforce. The impact of long COVID on their physical and mental health, and how it affects their work and home lives, remains largely unknown. As COVID-19 cases and hospitalisations rise again, protecting NHS staff is crucial. Research into long COVID among healthcare workers is needed to develop solutions for improving their health and ensuring they can continue delivering quality care. This research will help shape fair and effective policies to support the diverse NHS workforce.

Caring for the carers: understanding long covid in our diverse healthcare workforce, Amani Al-Oraibi, Katherine Woolf, Laura B Nellums, Carolyn Tarrant, Habib Naqvi, BMJ Opinion, https://doi.org/10.1136/bmj.o1152

This paper describes the methods used in work package 2 of the UK-REACH study. Early on in the pandemic it was evident that ethnic minority healthcare workers were more affected by COVID-19 but we didn’t know why. In this work package we have invited clinical and non-clinical healthcare workers across all four nations of the United Kingdom to fill in a series of surveys over the course of a year. The surveys include questions on ethnicity, job roles, home and family life, health and COVID-19. Participants have also agreed for this data to be joined to their healthcare records for up to 25 years. Using this data, we will explore how ethnicity relates to poor poor outcomes from COVID-19, including physical and mental health. We will also look at how other factors, such as living arrangements, explain any of the ethnic differences in outcomes we might find.

The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH): Protocol for a prospective longitudinal cohort study of healthcare and ancillary workers in UK healthcare settings, Katherine Woolf, Carl Melbourne, Luke Bryant, Anna L Guyatt, Chris McManus, Amit Gupta, Robert C Free, Laura Nellums, Sue Carr, Catherine John, Christopher A Martin, Louise V Wain, Laura J Gray, Claire Garwood, Vishant Modhwadia, Keith Abrams, Martin D Tobin, Kamlesh Khunti, Manish Pareek, BMJ Open, https://doi.org/10.1136/bmjopen-2021-050647

This paper sets out the research that will be undertaken for work packages 3, 4 and 5 of the UK-REACH study. Work package 3 explores the ethical and legal questions which arise from the study, and considers how UK-REACH (and projects like it) can be carried out in a legally and ethically acceptable way. To do this we will interview leaders in healthcare (e.g. NHS senior staff) and health research. we will also develop a policy report which will make recommendations as to how this type of research can be carried out. Work package 4 will explore healthcare workers’ experience of the Covid-19 pandemic through interviews and focus groups with staff from diverse backgrounds, to ensure voices are heard, shared and acted on. Work Package 5 is the UK-REACH stakeholder engagement group, comprising organisations which represent ethnic minority healthcare workers (i.e. the Filipino Nurses Association UK) as well as Royal Colleges and healthcare regulators, this group will provide feedback to researchers and help distribute findings widely across the healthcare sector and government to ensure the research has maximum impact.

Ethnicity and COVID-19 outcomes among healthcare workers in the United Kingdom: UK-REACH ethico-legal research, qualitative research on healthcare workers’ experiences, and stakeholder engagement protocol, Mayuri Gogoi, Ruby Reed-Berendt, Amani Al-Oraibi, Osama Hassan, Fatimah Wobi, Amit Gupta, Ibrahim Abubakar, Edward S Dove, Laura B Nellums, Manish Pareek, BMJ Open, https://dx.doi.org/10.1136/bmjopen-2021-049611

Vaccines are vital in the fight against Covid-19. Healthcare workers are at greater risk of catching Covid-19, so they were among the first to be offered vaccines. Despite this, early data suggested that some healthcare workers were not accepting vaccines. We wanted to find out which healthcare workers were hesitant and find ways to increase vaccine uptake to protect staff and patients. We surveyed 15,000 healthcare staff and interviewed nearly 70 to find out what they thought about Covid-19 vaccines. Healthcare workers were more likely to be hesitant if they were younger, female, from certain ethnic minority groups, pregnant, or had already had Covid-19. Lack of trust was also a major factor. Those who were hesitant were less likely to trust vaccines generally, were less likely to trust their employer, and were more likely to believe Covid-19 conspiracies. They described worrying about whether vaccines were safe and find it hard to know which information to trust. We recommended involving more people from ethnic minority groups in challenging vaccine myths and giving clear information about how safe and effective Covid-19 vaccines are for ethnic minority groups, pregnant people, and people who have already had Covid-19.

Ethnic differences in SARS-CoV-2 vaccine hesitancy in United Kingdom healthcare workers: Results from the UK-REACH prospective nationwide cohort study, Katherine Woolf, Ian Christopher McManus, Christopher A Martin, Laura B Nellums, Anna Louise Guyatt, Carl Melbourne, Luke Bryant, Mayuri Gogoi, Fatimah Wobi, Amani Al-Oraibi, Osama B Hassan, Amit Gupta, Catherine John, Martin D Tobin, Susan Carr, Sandra Simpson, Bindu Gregary, Avinash Aujayeb, Stephen Zingwe, Rubina Reza, Laura J Gray, Kamlesh Khunti, Manish Pareek, UK-REACH Study Collaborative Group, The Lancet Regional Health Europe, https://doi.org/10.1016/j.lanepe.2021.100180

This research paper describes the methods we will be using to complete work package 1 of the UK-REACH study. In this programme of work we aim to use existing data on UK health care workers to compare the number of COVID infections, hospitalisations and deaths by ethnicity. We will gather data about health care workers from: 1) Health and social care regulators. Many health care professions are required by government to be registered with a regulator, such as doctors, nurses, pharmacists and paramedics in order to work in the UK. 2) NHS human resources data. The NHS keeps detailed records on all employees. These data will include anyone employed by the NHS so will cover roles which are not regulated. These data will combined to form our study cohort. We will include people from the 1st February 2020 and follow them up for at least 12 months. We will link these data to health care records so we have information on whether health care workers developed COVID, were hospitalised, or died. All data will be anonymised and be accessed by researchers through a trusted research environment. This is a highly secure way of accessing sensitive data without the data being given to the researchers. Our results will be submitted for publication in a journal and also shared on the study website.

United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK- REACH): a retrospective cohort study using linked routinely collected data, study protocol, Lucy Teece, Laura J Gray, Carl Melbourne, Chris Orton, David V Ford, Christopher A Martin, David McAllister, Kamlesh Khunti, Martin Tobin, Catherine John, Keith R Abrams, Manish Pareek & The UK- REACH Study Collaborative Group, BMJ Open, Volume 11, https://doi.org/10.1136/bmjopen-2020-046392

This article analyses the legal and ethical issues raised by so-called ‘Big Data’ research projects in the Covid-19 era. It also considers how these issues might be addressed in a way that supports positive values, such as respecting participants, and mitigates or eliminates any negative concerns, such as worsening social inequality and injustice. The analysis is then applied to the UK-REACH project. The article argues that Big Data protects can be conducted in an ethically robust manner, and that sponsors and funders ought to encourage this to drive evidence-based policy in public health. The article proposes that projects ought to adopt a Big Data Ethics by Design approach. This principle holds that ethical values and principles in Big Data health research projects are best adhered to when they are already integrated into the projects aims and methods at the design stage.

The Ethical Implications of Big Data Research in Public Health: “Big Data Ethics by Design” in the UK‐REACH Study, Ruby Reed‐Berendt, Edward S. Dove, Manish Pareek, UK‐REACH Study Collaborative Group, Ethics & Human Research, Volume 44, Issue 1, Page 2-17, Dec. 22, 2021 https://doi.org/10.1002/eahr.500111

In the first UK-REACH paper of vaccine hesitancy in UK healthcare workers, we found that around a quarter were hesitant about taking the COVID-19 vaccine despite their clinical knowledge and experience of COVID-19. We built on this initial work to undertake something called a ‘phenomic analysis’ where we explored over 250 measures to see how they were associated with vaccine hesitancy, including social, cognitive and behavioural assessments. The statistical analysis looked not only at immediate predictors of hesitancy, but also predictors of the predictors, predictors of those predictors, and so on. Of the six measures directly related to hesitancy, two were cognitive -- greater COVID-19 conspiracy theory beliefs, and more negative attitudes towards vaccines in general -- and the other four were being younger, being pregnant, not having had a flu vaccine, and pessimism about the vaccination programme. The two cognitive measures were themselves associated with the psychological trait of fatalism, which assesses beliefs about predetermination, luck and pessimism. Fatalism, in turn, was related to religion being important in daily life, which varies by ethnicity, and to aspects of personality, including locus of control and need for closure. Our analysis has shown that vaccine hesitancy is a part of a complex network of behaviours, and understanding these will likely help in designing targeted interventions for particular groups of healthcare workers and the general population.

Vaccine hesitancy for COVID-19 explored in a phenomic study of 259 socio-cognitive-behavioural measures in the UK-REACH study of 12,431 UK healthcare workers, I Chris McManus, Katherine Woolf, Christopher A Martin, Laura B Nellums, Anna L Guyatt, Carl Melbourne, Luke Bryant, Amit Gupta, Catherine John, Martin D Tobin, Sue Carr, Sandra Simpson, Bindu Gregary, Avinash Aujayeb, Stephen Zingwe, Rubina Reza, Laura J Gray, Kamlesh Khunti, Manish Pareek, BMJ Open, https://doi.org/10.1101/2021.12.08.21267421

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