Mixed-methods process evaluation of a residence-based SARS-CoV-2 testing participation pilot on a UK university campus during the COVID-19 pandemic

H Blake, S Carlisle, L Fothergill, J Hassard, A Favier, J Corner, J K Ball, C Denning, H Blake, S Carlisle, L Fothergill, J Hassard, A Favier, J Corner, J K Ball, C Denning

Abstract

Background: Regular testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is an important strategy for controlling virus outbreaks on university campuses during the COVID-19 pandemic but testing participation rates can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel intervention implemented at two student residences on a large UK university campus over 4 weeks. The aim of the pilot was to increase the frequency of asymptomatic SARS-CoV-2 saliva testing onsite. This process evaluation aimed to determine whether RB-TPP was implemented as planned and identify implementation barriers and facilitators.

Methods: A mixed-methods process evaluation was conducted alongside the RB-TPP. Evaluation participants were students (opting in, or out of RB-TPP) and staff with a role in service provision or student support. Monitoring data were collected from the intervention delivery team and meeting records. Data were collected from students via online survey (n = 152) and seven focus groups (n = 30), and from staff via individual interviews (n = 13). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the 'Capability, Opportunity, Motivation-Behaviour' (COM-B) behaviour change framework.

Results: Four hundred sixty-four students opted to participate in RB-TPP (98% of students living onsite). RB-TPP was implemented broadly as planned but relaxed social distancing was terminated early due to concerns relating to national escalation of the COVID-19 Delta variant, albeit testing continued. Most students (97.9%) perceived the period of relaxed social distancing within residences positively. The majority engaged in asymptomatic testing (88%); 46% (52% of testers) were fully compliant with pre-determined testing frequency. Implementation was facilitated by convenience and efficiency of testing, and reduction in the negative impacts of isolation through opportunities for students to socialise. Main barriers to implementation were perceived mixed-messages about the rules, ambivalent attitudes, and lack of adherence to COVID-19 protective measures in the minority.

Conclusions: This process evaluation identifies factors that help or hinder the success of university residence-based outbreak prevention and management strategies. RB-TPP led to increased rates of SARS-CoV-2 testing participation among students in university residences. Perceived normalisation of university life significantly enhanced student mental wellbeing. The complexity and challenge generated by multiple lines of communication and rapid adaptions to a changing pandemic context was evident.

Trial registration number: UKAS 307727-02-01; Pre-results.

Clinicaltrials: gov Identifier: NCT05045989 ; post-results (first posted, 16/09/21).

Ethical approval: Faculty of Medicine & Health Sciences Research Ethics Committee, University of Nottingham (Ref: FMHS 96-0920).

Keywords: COVID-19; Complex interventions; Implementation; Mixed-methods; Process evaluation; Public health; SARS-CoV-2; Universities.

Conflict of interest statement

CD is Academic Lead and cofounder of the University of Nottingham Asymptomatic Testing Service (UoN ATS). AF and JKB are cofounders of UoN ATS. JC sits on the University of Nottingham Executive Board. None were involved in process evaluation data collection or analysis. HB is a behavioural advisor for the ATS; JKB is ATS virology advisor. Neither were involved in service delivery. SC, LF, JH reported no potential conflicts of interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Logic Model for Residence-Based SARS-CoV-2 Testing Participation Pilot
Fig. 2
Fig. 2
Process Evaluation Data Collection

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