4.4. Study Strengths and Limitations
To our knowledge, this is the first study to explore in depth, the perceptions and experiences of students and staff following delivery of a mass SARS-Cov-2/COVID-19 testing programme in a university setting. This study demonstrates the perceived value of the mass testing approach to students and staff in a higher education setting, although the economic and health impact of this approach is yet to be established. Study findings will inform future deployments of COVID-19 virus and antibody testing on university campuses and may provide insights to inform the roll-out of COVID-19 vaccines in the future. However, these findings should be considered in the context of the environment in which this pilot deployment was delivered (a single campus of a multi-campus university, in a semirural location), at a time of frequent changes in patterns of virus transmission. The data were collected prior to the second surge of COVID-19 in the UK at which time the participating university deployed mass testing more broadly to include students living on its other campuses closer to the city. In these subsequent deployments, a large number of positive cases were detected, leading to high numbers of students self-isolating, and this was coupled with lower uptake of mass testing among students. Therefore, our findings may not be directly transferable to different settings or across rapidly changing national and local contexts. The reasons for the subsequent reduction in testing uptake, apparent changes in students’ attitudes to testing and the barriers and enablers of self-isolation need to be explored. This is particularly pertinent in the light of the government’s adoption of a phased return of students to UK universities in January 2021, whereby students returning to campus first may be subject to successive waves of virus exposure bringing the possibility of needing to self-isolate more than once.
Validity was strengthened as data were collected and analysed by researchers who were not involved in the delivery of the testing programme. There were more female than male participants in our study (no students identified as non-binary), which reflects the gender balance of students completing a veterinary degree, with proposed figures of 77% [25] and 80% [26], but is higher than the proportion of females across all higher education students in the UK, estimated to be 57% [27]. Due to the cross-sectional survey data collected in this study, it is not possible to determine the temporal nature of any associations presented here (i.e., whether the P-ATS led to any psychological or behavioural changes). The small sample size may affect the generalisability of results, although the survey response rate was adequate to address the study aims. Similarly, given the aim of the study, the sample specificity, the rich dataset, in-depth insights into the phenomena of interest and the analysis approach adopted [28], the qualitative sample was deemed to have sufficient information power, although further insights from a larger sample of staff may be valuable for future research. The positive evaluation should be interpreted in the light of known drawbacks of universal testing such as false-positive and false-negative tests, the difficulty of defining an active infection and significant resource implications [29,30].