Developing an intervention to maintain biweekly asymptomatic SARS-CoV-2 testing amongst English care home staff: An integrative approach

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Abstract
Purpose: To describe the development of an intervention (‘ Test to Care’ ) maintaining biweekly asymptomatic SARS-CoV-2 testing amongst care home staff. Methods: Diverse inputs were sequentially integrated: 1 ) A behaviour change wheel (BCW) analysis of the results from a systematic review of barriers and facilitators to staff testing for SARS-CoV-2 from 14 international studies to generate initial intervention content ideas; 2 ) A series of eight stakeholder events with UK care home staff and policy makers (N=∼70) to iteratively operationalise emerging intervention content; 3 ) Confirmatory thematic analysis of barriers and facilitators to biweekly asymptomatic SARS-CoV-2 testing from four focus groups (N=15) to check temporal relevance of the intervention; 4) Intervention specification via programme theory and a logic model. Results: Narrative programme theory and a simple logic model described ‘ Test to Care ’. It showed the primary intervention function was ‘ incentivisation’, addressing agency backfill and sick pay. Secondary intervention functions included: ‘ education ’ and ‘ persuasion ’ to staff through communications and social marketing (i.e., posters and emails with embedded short videos); and ‘ environmental/social restructuring ’ and ‘ enablement ’ which invited managers to initiate and support implementation (i.e., the location of testing, management support and poster locations). Conclusions: Our integrative approach to intervention development produced an evidence-based, theoretically-informed intervention tailored to its specific implementation context. The diversity of included inputs were essential to overcome the relative weaknesses and strengths of each input source (e.g., the historical timeframe of published studies in the review, and the sampling biases associated with focus group participation). What is already known on this subject?: During the global COVID-19 pandemic, compliance with SARS-CoV-2 testing and other non-pharmaceutical interventions amongst care home staff was enforced through intervention functions such as ‘coercion’ and ‘restriction’ (e.g., mandatory routine testing). However, little is known about how to maintain testing when these intervention functions are removed. Intervention development guidance suggests optimal processes should combine the published literature, stakeholder engagement, and programme theory. However, few examples illustrate this process in detail. What does this study add?: We present a worked example of using diverse inputs to systematically develop an intervention within a compressed time frame: a typical behaviour change wheel analysis of findings (i.e., barriers and facilitators) from international published studies, novel iterative stakeholder input to add/remove and operationalise intervention content, and sense-checking the emerging intervention’s relevance within the context in which the intervention will be used. Uniquely, the study also shows how narrative programme theory and logic models can be used to illustrate an intervention and its purported functions: numerous intervention functions are required (i.e., ‘incentivisation’, ‘education’, ‘persuasion’, ‘environmental/social restructuring’ and ‘enablement’), as are varied behaviour change techniques addressing a range of important mechanisms of action (i.e., ‘knowledge’, ‘beliefs about consequences’, ‘professional role and identity’, ‘social influence’, ‘environmental context and resource’, ‘behavioural regulation’ and ‘memory attention and decision-making’).

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