Holly Carter

• Doctor of Psychology
• Researcher at Public Health England

Major incident inquiries and research highlight persistent problems in interoperability. Evidence points to failures in the ability of responders from different organisations to work effectively together, which hinders collaborative efforts. Recently, researchers have argued that one reason why collaboration problems exist when different teams are...

As many individuals with Long Covid are left without formal support, they have turned to online support groups for help. Previous research has shown that online support groups may improve group members’ wellbeing, but there is limited evidence on the role of group moderators in influencing such outcomes. Applying the social identity approach to lea...

Online support groups provide support to people with Long Covid in the absence of formal treatment, but their effects on health outcomes are unclear. In this longitudinal study, we examined the role of shared social identity with an online support group, external psychological resources (support and connection), internal psychological resources (me...

This pre-registered systematic review aimed to examine whether online support groups affect the health and wellbeing of individuals with a chronic condition, and what mechanisms may influence such effects. In September 2024, literature searches were conducted across electronic databases (Medline, Embase, PsycInfo, Web of Science and Google Scholar)...

Background Whilst healthcare workers (HCWs) are at high risk of contracting infectious viral diseases, such as COVID-19, measures can be put in place to reduce the spread of diseases in healthcare settings. These currently include the use of different types of masks: fluid-resistant surgical masks (FRSM) and filtering facepiece (FFP3) respirators....

This article is an example of ‘Lessons from the Field’. Recent inquests following major incidents in the United Kingdom have criticised the ‘care gap’—the time period between an incident occurring and emergency services accessing casualties to deliver life‐saving interventions. To address this, Ten Second Triage (TST) was developed in the United Ki...

Recent inquests following major incidents in the UK have criticised the ‘care gap’ – the time period between an incident occurring and emergency services accessing casualties to deliver life-saving interventions. To address this, the Ten Second Triage (TST) tool was developed in the UK to facilitate rapid non-physiological assessments by any first...

Background The impact of the COVID-19 pandemic was felt disproportionately by people with Special Educational Needs and Disabilities (SEND), with a substantially higher mortality rate compared with the general population. Method Using focus groups and thematic analysis with young people with Special Educational Needs and Disabilities (SEND) this st...

As many individuals with Long Covid are left without formal support, they have turned to online support groups for help. In a pre‐registered study, interviews were carried out with 21 adults with Long Covid to explore experiences of using online support groups, to understand whether participants felt these experiences influenced their health and we...

Major incident inquiries and research highlight persistent problems in interoperability. Evidence points to failures in the ability of responders from different organisations to work effectively together, which hinders collaborative efforts. Recently, researchers have argued that the reason why collaboration problems exist when different teams are...

Previous research has shown ongoing difficulties between Police, Fire and Rescue, and Ambulance Service responders during multi-agency emergencies. Recently, researchers have used the Social Identity Approach to gain insight into these challenges, offering a psychological framework for understanding relations within and between response organisatio...

OBJECTIVE: This systematic review examines whether online support groups affect the health and wellbeing of individuals with a chronic condition, and what mechanisms may influence such effects. METHOD: In February 2023, literature searches were conducted across electronic databases (Medline, Embase, PsycInfo, Web of Science and Google Scholar), pre...

During the COVID-19 pandemic, concerns were raised that face covering use may elicit risk compensation; a false sense of security resulting in reduced adherence to other protective behaviours such as physical distancing. This systematic review aimed to investigate the effect of face covering use on adherence to other COVID-19 related protective beh...

The COVID-19 pandemic has shown that all emergencies, major incidents and disease outbreaks can have substantial mental health consequences, and it has demonstrated the proven need for additional care for populations in the wake of disasters. This book brings together practice and recent developments in pre-hospital emergency care, emergency medici...

Whilst healthcare workers (HCWs) are at high risk of contracting COVID-19, measures can be put in place to reduce the spread of COVID-19 and other respiratory infections in healthcare settings. These currently include the use of masks: fluid-resistant surgical masks and respiratory protective equipment. However, for mask policies to be effective, c...

Background: Children spend significant amounts of time at school, making the school environment a potentially important contributor to air quality exposure. Aim: The SAMHE project has a dual aim: 1) to develop and test a bespoke citizen science framework for collecting environment and indoor air quality data in classrooms, alongside contextual dat...

Objective The aim of this study was to compare the effects of different types of COVID-19 certification policy on subsequent behavioural expectations. Design 4 × 2 between-subjects pre-registered randomised controlled trial. Method In August 2022, participants (n = 2726) in England were presented with a scenario describing a rise in COVID-19 infe...

Previous research demonstrates the persistent challenges between Police, Fire and Rescue, and Ambulance responders during multi-agency emergency response. Recently, the Social Identity Approach has been used as a theoretical guide to better understand these challenges through providing a psychological framework to understand relations within and be...

Research has recently highlighted the importance of a psychological understanding of interoperability in multi-agency emergency response to provide insight into why problems in the implementation of interoperability continue to persist, and what can be done to prevent them reoccurring in the future. We developed a training tool on how psychology ca...

Objectives Communities in North West England had some of the highest incidence of COVID-19, particularly in their younger populations. Test kits were provided to young people in Blackburn with Darwen to encourage regular testing and reduce COVID-19 transmission. The aim of this study was to identify barriers and facilitators to engaging in regular...

Objective To understand the public perceptions of the schools Covid-19 testing programme in England. Design Qualitative social media analysis. Setting Online users of parenting forums (Mumsnet and Netmums), Facebook newspaper pages and Daily Mail online readers, who responded to posts or articles about the schools testing programme in England, be...

Introduction The frequency of assaults on police officers in the United Kingdom is rising and evidence suggests that exposure to work-place violence can negatively impact wellbeing, for example, increased perceived stress, feeling worn out and tired, and emotional exhaustion. Despite the prevalence of assaults on police officers, little research ha...

During the COVID-19 pandemic, concerns were raised that face covering use may elicit risk compensation; a false sense of security resulting in reduced adherence to other protective behaviours such as physical distancing. This systematic review aimed to investigate the effect of face covering use on adherence to other COVID-19 related protective beh...

Previous research demonstrates the persistent challenges in multi-agency emergency response. Recently, the Social Identity Approach has been used to better understand these challenges through providing a psychological framework to analyse relations within- and between-responder groups. The current study expands on this through six discussion-based...

This briefing document is part of the ESRC-funded project ‘Perceived threats and “stampedes”: a relational model of collective fear responses’ (project reference ES/T007249/1).

Objective: To understand the public perceptions of the schools testing programme in England. Design: Qualitative social media analysis. Setting: Online users of parenting forums (Mumsnet and Netmums), Facebook and Daily Mail online readers, who responded to randomly selected posts or articles about the schools testing programme in England, between...

Recent research has shown that multiagency emergency response is beset by a range of challenges, calling for a greater understanding of the way in which these teams work together to improve future multiagency working. Social psychological research shows that a shared identity within a group can improve the way in which that group works together and...

During the COVID‐19 pandemic, the United Kingdom implemented physical distancing measures to minimize viral transmission, which may have adversely impacted health and wellbeing. Evidence suggests that social support may be key to mitigating against adverse health impacts of such measures, particularly when such social support is identity‐based. In...

Seasonal changes in the measured CO2 levels at four schools are herein presented through a set of indoor air quality metrics that were gathered during the height of the COVID-19 pandemic in the UK. Data from non-intrusive environmental monitoring units were remotely collected throughout 2021 from 36 naturally ventilated classrooms at two primary sc...

Purpose – It is essential to understand how members of the public make decisions during emergencies. Such understanding is crucial in order to understand how emergency services can best influence positive protective behaviours. Previous research in this area has indicated that members of the public will respond both to the threat from an incident s...

Objective: We examined whether varying information about long COVID would affect expectations about the illness. Method: In October 2021, we conducted a 2 (Illness Description: long COVID vs. ongoing COVID-19 recovery) × 2 (Symptom Uncertainty: uncertainty emphasized vs. not emphasized) × 2 (Efficacy of Support: enhanced vs. basic support) between-...

Recent research has shown that multi-agency emergency response is beset by a range of challenges, calling for a greater understanding of the way in which these teams work together to improve future multi-agency working. Social psychological research shows that a shared identity within a group can improve the way in which that group works together a...

Purpose Human Behaviour during emergency situations is a crucial component of any response. The ability of responders to effectively engage with casualties is critical to ensuring that any instructions given are followed and in doing assist rather than hinder the response. In order to improve the likelihood of this occurring it is essential to unde...

Previous research shows there are persistent challenges with multi-agency response centring on problems of communication and coordination. The Social Identity Approach provides an important psychological framework for analysing relations within and between groups which can be used to understand why challenges in multi-agency response occur, and wha...

Objectives Care homes have experienced a high number of COVID-19 outbreaks, and it is therefore important for care home employees to receive the COVID-19 vaccine. However, there is high vaccine hesitancy among this group. We aimed to understand barriers and facilitators to getting the COVID-19 vaccine, as well as views on potential mandatory vaccin...

Previous research shows there are persistent challenges with multi-agency response centring on problems of communication and coordination. The Social Identity Approach provides an important psychological framework for analysing relations within and between groups which can be used to understand why challenges in multi-agency response occur, and wha...

Objectives Individuals who receive a negative lateral flow coronavirus test result may misunderstand it as meaning ‘no risk of infectiousness’, giving false reassurance. This experiment tested the impact of adding information to negative test result messages about residual risk and the need to continue protective behaviours. Design 4 (residual ris...

Background: From 9th April 2021, everyone in England has been encouraged to take two COVID-19 tests per week. This is the first time that national mass asymptomatic testing has been introduced in the UK and the effectiveness of the policy depends on uptake with testing and willingness to self-isolate following a positive test result. This paper exa...

Objectives We examined whether providing different types of information about Long COVID would affect expectations about the illness. Design A 2 (Illness description: Long COVID vs ongoing COVID-19 recovery) x 2 (Illness uncertainty: uncertainty emphasised vs uncertainty not emphasised) x 2 (Efficacy of support: enhanced support vs basic support)...

The aim of this narrative review was to explore the conditions under which enforcement likely is, or is not, an effective strategy to increase adherence to recommended protective behaviours during COVID-19. Relevant search terms were entered into four key databases (Google, Google Scholar, medXriv, and psyArXiv) to identify both academic and non-ac...

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 t...

Recent research has shown that multi-agency emergency response is beset by a range of problems, calling for a greater understanding of the way in which these teams work together to improve future multi-agency working. Social psychological research shows that a shared identity within a group can improve the way in which that group works together and...

Interviews with responders in pandemic multi-agency response teams (PMART) in the UK to examine the impact of co-location on multi-agency response, in particular investigating the psychological factors that might affect interoperability. This report is published in Volume 16, Issue 3 of The Crisis Response Journal - see https://www.crisis-response...

Objectives: Care homes have experienced a high number of COVID-19 outbreaks, and it is therefore important for care home employees to receive the COVID-19 vaccine. However, there is vaccine hesitancy at a greater rate among this group than in the wider community. We aimed to understand barriers and facilitators to getting the COVID-19 vaccine, as w...

Background. There is evidence that the COVID-19 pandemic has affected the mental health of the UK population, but this needs synthesising to guide effective policy recommendations and ensure support is targeted to populations most at risk. We conducted a rapid systematic review of the evidence of the impact of COVID-19 and associated restrictions o...

Background: From 9th April 2021, everyone in England has been encouraged to take two COVID-19 tests per week. This is the first time that national mass asymptomatic testing has been introduced in the UK and the effectiveness of the policy depends on uptake with testing and willingness to self-isolate following a positive test result. This paper exa...

Objectives. Individuals who receive a negative lateral flow coronavirus (Covid-19) test result may misunderstand it as meaning no risk of infectiousness, giving false reassurance. This experiment tested the impact of adding information to negative test result messages about (a) residual risk and (b) need to continue protective behaviours. Design. 4...

Objectives (1) To understand the experiences and perceptions of those who underwent supported isolation, particularly in relation to factors that were associated with improved compliance and well-being; (2) to inform recommendations for the management of similar supported isolation procedures. Design We carried out a qualitative study using semist...

Purpose: To explore the conditions under which enforcement likely is, or is not, an effective strategy to increase adherence to recommended protective behaviours during COVID-19. Design/Methodology/Approach: Relevant search terms were entered into three key databases (Google Scholar, medXriv, psyArXiv) to identify both peer-reviewed and pre-publica...

Background Mass asymptomatic testing for COVID-19 was piloted for the first time in the UK in Liverpool. There was an urgent need to rapidly evaluate acceptance of asymptomatic testing, specifically identifying barriers and motivators to taking part. Methods As part of the wider evaluation, we conducted a rapid thematic analysis of local narratives...

Background: Mass asymptomatic testing for COVID-19 was piloted for the first time in the UK 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, specific...

Planning for major incidents involving the release of hazardous chemicals has been informed by a multi-disciplinary research agenda which has sought to inform all aspects of emergency response, but with a focus in recent years on mass casualty decontamination. In vitro and human volunteer studies have established the relative effectiveness of diffe...

The Covid-19 pandemic presents a unique set of challenges for UK emergency responders due to the scale and complexity of the response required. The emergency services and partner agencies across the UK have come together within their Local Resilience Forums (LRF) to put a response in place. These usually independent teams have been required to work...

Objectives: To understand the experiences of those who underwent supported isolation as part of the response to the COVID-19 pandemic, after returning to the UK from Wuhan, China. Design: We used semi structured interviews to capture participants experiences and perceptions of supported isolation. Setting: Telephone interviews carried out within ap...

In the event of an incident involving the release of hazardous material (eg, chemical, biological, radiological, or nuclear agents), key actions can be taken to reduce harm and protect the people involved. The quicker actions can be taken, the less harm will occur. Guidance is, therefore, needed to help nonspecialist members of the public to act ra...

Background In the absence of a vaccine, behaviour by the public is key to the response to the COVID-19 pandemic. Yet, as with other types of crises and emergencies, there have been doubts about the extent to which the public are able to engage effectively with the required behaviour. These doubts are based on outdated models of group psychology. A...

The UK’s Initial Operational Response (IOR) decontamination protocol requires that chemically contaminated casualties remove contaminated clothing (disrobe) and then apply water or absorbent materials to skin. The health‐protective efficacy of the protocol is predicated on casualties quickly accepting both the need to act and the fact that this pro...

The United Kingdom has a wealth of experience in planning for and responding to major incidents and emergencies. Recent diverse examples include the suicide bomb attack at Manchester Arena and the Grenfell Tower fire, both in 2017; and the Salisbury nerve agent attack in 2018. Despite this, the Covid-19 pandemic presents a unique set of challenges...

This research examines the ways in which social media is used to organize and manage volunteers during a flood. Flooding is currently one of the top risks highlighted within the UK National Risk Register and ways to help those affected need to be explored further. Social media is a valuable tool in disaster management as it enables information to b...

This is the third in a series of ongoing reports that aim to understand the current challenges faced by Local Resilience Forums (LRFs) during the Covid-19 pandemic in the UK, with the goal of supporting the ongoing development of good working practice.

Objectives Malicious incidents involving chemical agents sometimes trigger high public concern. We aimed to (1) identify levels of emotion, perceived risk and behaviour change with regard to visiting Salisbury, 1 month after three people were poisoned with a nerve agent; and (2) test whether factors including receipt of information, beliefs about p...

The risk of chemical, biological, radiological and nuclear (CBRN) incidents has increased in recent years, due to advances in technology, and increased willingness of terrorists to use unconventional weapons. There are basic actions which can reduce or prevent harm during such incidents. The speed with which these actions can be taken may be enhanc...

This is the second in a series of ongoing reports that aim to understand the current challenges faced by Local Resilience Forums (LRFs) during the Covid-19 pandemic in the UK. The goal is to support the ongoing development of good working practice

Background In some organizations, traumatic events via direct or indirect exposure are routine experiences. The National Institute for Health and Care Excellence reviews (2005; 2018) of post-traumatic stress disorder management in primary and secondary care did not address early interventions for trauma within emergency response organizations. Aim...

This is the first in a series of ongoing reports that aim to understand the current challenges faced by Local Resilience Forums in the Covid-19 pandemic, with the aim of supporting the ongoing development of good working practice.

When addressing public behaviour during mass emergencies and disasters, it is important to consider that such emergencies and disasters will often involve crowds. An understanding of emergency crowds is therefore crucial in ensuring that incidents are managed as effectively as possible. The elaborated social identity model of crowd behaviour emphas...

The following deliverable is the third of the three set for the PROACTIVE project for WP1 – Human factors analysis of preparedness and response. In line with the activities of Task 1.3 and the requirements of D1.3, this deliverable collates outcomes from D1.1 and D1.2, specifically concerning both current policy and practice for mitigation and mana...

This chapter has three key aims. First, to describe research into likely public behaviour during mass emergencies, and to demonstrate how the way in which an incident is managed will affect the way in which members of the public respond. Second, to highlight how an effective responder management strategy can promote positive public behaviours durin...

The following deliverable is the second of the three set out for the PROACTIVE project for WP1 – Human factors analysis of preparedness and response. It reviews guidance documents relating to CBRNe incident management and aims to understand: (i) current policy and practice in the preparation for and management of CBRNe terrorism in different organi...

The following deliverable is the first of the three set for the PROACTIVE project for WP1 – Human factors analysis of preparedness and response. In line with the activities of Task 1.1 and the requirements of D1.1, this deliverable presents the findings from a review of academic literature relating to public perceptions of pre-incident preparedness...

[This corrects the article DOI: 10.3389/fpubh.2019.00141.].

Purpose In the event of a hazardous chemical release incident in the UK, affected members of the public would undergo improvised and interim forms of decontamination (the “Initial Operational Response” (IOR)). To enable members of the public to take recommended actions quickly, the Home Office and National Chemical, Biological, Radiological and Nu...

Accumulated evidence demonstrates the centrality of social psychology to the behavior of members of the public as immediate responders in emergencies. Such public behavior is a function of social psychological processes—in particular identities and norms. In addition, what the authorities and relevant professional groups assume about the social psy...

Chemical incidents require rapid action and intervention to minimise the risk of illness and injury to affected casualties. During pre-hospital emergency response, protected first responders will guide members of the public through evacuation, decontamination and triage. The ability of casualties to complete these steps may be confounded by their i...

The likelihood of major incidents and disasters has increased in recent years, due to climate change, urbanisation, and acts of terrorism. Effective management of such incidents is crucial to ensure that members of the public are able and willing to take appropriate protective actions. The workshop described in this paper brought together researche...

In the event of an incident involving the release of a hazardous chemical, first responders may decide to initiate emergency decontamination in order to remove any contaminant from affected casualties. Recent initiatives such as the UK Home Office-led Initial Operational Response Programme have introduced new evidence-based decontamination protocol...

Post-focus group questionnaire. (DOCX)

Information sheet. (DOCX)

Focus group scenario. (DOCX)

Three month follow up questionnaire. (DOCX)

Pre-focus group questionnaire. (DOCX)

Focus group interventions. (DOCX)

Focus group discussion guide. (DOCX)

Previous studies have demonstrated that rapid evacuation, disrobing and emergency decontamination can enhance the ability of emergency services and acute hospitals to effectively manage chemically-contaminated casualties. The purpose of this human volunteer study was to further optimise such an “Initial Operational Response” by (1) identifying an a...

Draft improvised dry decontamination guidance and instructions. (DOCX)

Study 2—Post-decontamination questionnaire. (DOCX)

Study 2—Scenario. (DOCX)