Barriers in accessing healthcare during the COVID-19 pandemic: analysis of the Virus Watch community cohort study

Background: Differential barriers to accessing healthcare contribute to inequitable health outcomes. This study aims to describe the characteristics of individuals who experienced barriers, and what those barriers were, during the COVID-19 pandemic. Methods: We analysed data from Virus Watch: an online survey-based community study of households in England and Wales. The primary outcome was reported difficulty accessing healthcare in the previous year. Results: Minority ethnic participants reported difficulty accessing healthcare more than White British participants (41.6% vs 37%), while for migrants this was at broadly similar levels to non-migrants. Those living in the most deprived areas reported difficulty more than those living in the least deprived quintile (45.5% vs. 35.5%). The most frequently reported barrier was cancellation/disruption of services due to the COVID-19 pandemic (72.0%) followed by problems with digital or telephone access (21.8%). Ethnic minority participants, migrants, and those from deprived areas more commonly described 'insufficient flexibility of appointments' and 'not enough time to explain complex needs' as barriers. Conclusions: Minority ethnic individuals and those living in deprived areas were more likely to experience barriers to healthcare during the COVID-19 pandemic, and it is essential they are addressed as services seek to manage backlogs of care. ### Competing Interest Statement AH serves on the UK New and Emerging Respiratory Virus Threats Advisory Group. All other authors declare no competing interests. ### Funding Statement Virus Watch was supported by the Medical Research Council [Grant Ref: MC_PC 19070 and MR/V028375/1]. The study also received $15000 of advertising credit from Facebook to support a pilot social media recruitment campaign on 18 August 2020. The antibody testing was also supported by funding from the Department of Health and Social Care from February 2021 to March 2022. This study was also supported by the Wellcome Trust through a Wellcome Clinical Research Career Development Fellowship to R.W.A. [206602]. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Approval and Consent Virus Watch was approved by the Hampstead NHS Health Research Authority Ethics Committee: 20/HRA/2320, and conformed to the ethical standards set out in the Declaration of Helsinki. All participants provided informed consent for all aspects of the study I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes We aim to share aggregate data from this project on our website and via a "Findings so far" section on our website: https://ucl-virus-watch.net/. We also share some individual record level data on the Office of National Statistics Secure Research Service. In sharing the data we will work within the principles set out in the UKRI Guidance on best practice in the management of research data. Access to use of the data whilst research is being conducted will be managed by the Chief Investigators (AH and RA) in accordance with the principles set out in the UKRI guidance on best practice in the management of research data. We will put analysis code on publicly available repositories to enable their reuse. We aim to share aggregate data from this project on our website and via a "Findings so far" section on our website: https://ucl-virus-watch.net/. We also share some individual record level data on the Office of National Statistics Secure Research Service. In sharing the data we will work within the principles set out in the UKRI Guidance on best practice in the management of research data. Access to use of the data whilst research is being conducted will be managed by the Chief Investigators (AH and RA) in accordance with the principles set out in the UKRI guidance on best practice in the management of research data.