‘Smart’ BLE wearables for digital contact tracing in care homes during the COVID-19 pandemic—a process evaluation of the CONTACT feasibility study

Thompson, Carl A.; Daffu-O’Reilly, Amrit; Willis, Thomas; Gordon, Adam; Noakes, Catherine; Khaliq, Kishwer; Farrin, Amanda; Kemp, Andrew; Hall, Tom; Bojke, Chris; Spilsbury, Karen

Abstract

Background: Rapid and mass transmission of the SARS-CoV-2 virus amongst vulnerable people led to devastating effects from COVID-19 in care homes. The CONTACT intervention introduced Bluetooth Low Energy ‘smart’ wearable devices (BLE wearables) as a basis for automated contact tracing in, and feedback on infection risks and patterns to, care homes to try and improve infection prevention and control (IPC). We planned a cluster randomised controlled trial (RCT) of CONTACT. To be feasible, homes had to adopt CONTACT’s technology and new ways of working. This paper reports on the process evaluation conducted alongside CONTACT’s feasibility study and explains why it lacked the feasibility and acceptability for a definitive RCT. Methods: This mixed method process evaluation used Normalisation Process Theory (NPT) qualitative (interviews, field notes, study case report forms and documents, and observation) and quantitative (survey instruments, counts of activity) data to plan, implement, and analyse the mechanisms, effects, and contextual factors that shaped the feasibility and acceptability of the CONTACT intervention. Results: Thirteen themes within four core NPT constructs explained CONTACT’s lack of feasibility. Coherence: the home’s varied in the scale and extent of commitment and understanding of the technology and study procedures. Leadership credibility was important but compromised by competing priorities. Management and direct care staff saw CONTACT differently. Work to promote (cognitive participation) and enact (collective action) CONTACT was burdensome and failed to be prioritised over competing COVID-19-related demands on time and scarce human and cognitive resources. Ultimately, staff appraisal of the value of CONTACT-generated information and study procedures (reflexivity) was that any utility for IPC was insufficient to outweigh the perceived burden and complexity involved. Conclusions: Despite implementation failure, dismissing BLE wearables’ potential for contact tracing is premature. In non-pandemic conditions, with more time, better co-design and integration of theory-driven implementation strategies tailored to care homes’ unique contexts, researchers could enhance normalisation in readiness for future pandemic challenges. Trial registration: ISRCTN registration: 11,204,126 registered 17/02/2021.

Citation

Thompson, C. A., Daffu-O’Reilly, A., Willis, T., Gordon, A., Noakes, C., Khaliq, K., …Spilsbury, K. (2023). ‘Smart’ BLE wearables for digital contact tracing in care homes during the COVID-19 pandemic—a process evaluation of the CONTACT feasibility study. Implementation Science Communications, 4(1), Article 155. https://doi.org/10.1186/s43058-023-00533-0

• Journal Article Type: Article
• Acceptance Date: Nov 21, 2023
• Online Publication Date: Dec 4, 2023
• Publication Date: 2023
• Deposit Date: Jan 24, 2024
• Publicly Available Date: Jan 24, 2024
• Journal: Implementation Science Communications
• Print ISSN: 2662-2211
• Electronic ISSN: 2662-2211
• Publisher: BioMed Central
• Peer Reviewed: Peer Reviewed
• Volume: 4
• Issue: 1
• Article Number: 155
• DOI: https://doi.org/10.1186/s43058-023-00533-0
• Keywords: Care homes, Contact tracing, Process evaluation, COVID-19, Digital, Normalisation Process Theory, Long-term care, BLE Wearables
• Public URL: https://nottingham-repository.worktribe.com/output/28417095
• Publisher URL: https://link.springer.com/article/10.1186/s43058-023-00533-0
• Additional Information: Received: 7 August 2023; Accepted: 21 November 2023; First Online: 4 December 2023; : ; : CONTACT’s feasibility study and associated process evaluation received approval as part of the CONTACT study by the UK Health Research Authority (REC: 294390).; : All images have been reproduced with permission from copyright holders.; : During the COVID-19 pandemic, CN was a participant in the UK Scientific Advisory Group for Emergencies (SAGE), co-chaired the SAGE Environment and Modelling Sub-Group, and was a member of the SAGE care home working group. CT has previously provided paid scientific advice to Microshare Ltd and has presented to the SAGE care home working group.