Local Community Response to Mass Asymptomatic COVID-19 Testing in Liverpool, England: Social Media Analysis

Charlotte Robin, Charles Symons, Holly Carter

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Mass asymptomatic testing for COVID-19 was piloted for the first time in the United Kingdom in Liverpool in November 2020. There is limited evidence on uptake of mass testing, and previously where surge testing has been deployed, uptake has been low. Objective: There was an urgent need to rapidly evaluate acceptance of asymptomatic testing, specifically identifying barriers and facilitators to taking part. Methods: As part of the wider evaluation, we conducted a rapid thematic analysis of local community narratives on social media to provide insights from people unlikely to engage in testing or other standard evaluation techniques, such as surveys or interviews. We identified 3 publicly available data sources: the comments section of a local online newspaper, the city council Facebook page, and Twitter. Data were collected between November 2, 2020, and November 8, 2020, to cover the period between announcement of mass testing in Liverpool and the first week of testing. Overall, 1096 comments were sampled: 219 newspaper comments, 472 Facebook comments, and 405 tweets. Data were analyzed using an inductive thematic approach. Results: Key barriers were accessibility, including site access and concerns over queuing. Queues were also highlighted as a concern due to risk of transmission. Consequences of testing, including an increase in cases leading to further restrictions and financial impact of the requirement for self-isolation, were also identified as barriers. In addition, a lack of trust in authorities and the test (including test accuracy and purpose of testing) was identified. Comments coded as indicative of lack of trust were coded in some cases as indicative of strong collective identity with the city of Liverpool and marginalization due to feeling like test subjects. However, other comments coded as identification with Liverpool were coded as indicative of motivation to engage in testing and encourage others to do so; for this group, being part of a pilot was seen as a positive experience and an opportunity to demonstrate the city could successfully manage the virus. Conclusions: Our analysis highlights the importance of promoting honest and open communication to encourage and harness existing community identities to enhance the legitimacy of asymptomatic testing as a policy. In addition, adequate and accessible financial support needs to be in place prior to the implementation of community asymptomatic testing to mitigate any concerns surrounding financial hardship. Rapid thematic analysis of social media is a pragmatic method to gather insights from communities around acceptability of public health interventions, such as mass testing or vaccination uptake.

Original languageEnglish
Article numbere34422
JournalJMIR Formative Research
Issue number8
Publication statusPublished - 1 Aug 2022

Bibliographical note

Funding Information:
The authors would like to acknowledge all those involved in the evaluation of the asymptomatic testing pilot in Liverpool including colleagues at the University of Liverpool, Department of Health and Social Care, National Health Service (NHS) Test and Trace, Joint Biosecurity Centre, Cabinet Office, and Office of National Statistics. We would also like to extend our gratitude to Liverpool City Council and residents in the Liverpool City Region. CR and HC are affiliated with the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behavioural Science and Evaluation at University of Bristol, in partnership with the UK Health Security Agency (UKHSA). CR is also affiliated with the NIHR HPRU Emerging and Zoonotic Infections at the University of Liverpool in partnership with the UKHSA, in collaboration with the Liverpool School of Tropical Medicine and The University of Oxford, and the NIHR HPRU in Gastrointestinal Infections at University of Liverpool in partnership with UKHSA, in collaboration with the University of Warwick. HC is also affiliated with the NIHR HPRU in Emergency Preparedness and Response, a partnership between the UKHSA, King's College London, and the University of East Anglia. CR and HC are based at UKHSA. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health, or the UKHSA.

Publisher Copyright:
©Charlotte Robin, Charles Symons, Holly Carter. Originally published in JMIR Formative Research (https://formative.jmir.org), 04.08.2022.


  • COVID-19
  • England
  • acceptance
  • asymptomatic testing
  • attitude
  • barrier
  • behavior
  • behavioral science
  • communication
  • community
  • hesitancy
  • motivator
  • social media
  • testing


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