Adapting the Germ Defence web-based intervention to improve infection prevention and control in care homes: a qualitative study (Preprint)

Abstract

BACKGROUND Infection prevention and control (IPC) is vital in care homes, as it can reduce morbidity and mortality by 30%. Ensuring good IPC practice is a perennial challenge in the varied and complex context of care homes. Behaviour change interventions, delivered via digital technology, may be effective in improving IPC among care home staff. OBJECTIVE This study aimed to evaluate how an evidence-based, digital behaviour change intervention called Germ Defence can be rapidly adapted to meet the needs of care homes. METHODS The study applied the person-based approach, which emphasises iterative approaches to optimising interventions via individual user feedback. Phase 1 involved initial edits to the website by the research team to create Germ Defence for Care Homes (GDCH) Version 1. Phase 2 consisted of stakeholder consultation on GDCH Version 1 followed by edits to create GDCH Version 2. The formal research (Phases 3 and 4) involved individual think-aloud interviews with 21 staff from management, care and ancillary positions in four care homes, giving real-time feedback as they worked through GDCH. Edits were made to create GDCH Version 3 between Phases 3 and 4. During the development of GDCH Versions 2 and 3, it became clear that the intervention would need more fundamental changes beyond the pragmatic, incremental changes that would be possible in the scope of the study. Analysis was completed via a rapid, qualitative descriptive approach to develop a high-level summary of key findings from the interview data. RESULTS There were mixed results about the attractiveness of GDCH and its suitability to the care home context. Participants felt that the images needed to be aligned much more closely with the meaning of adjacent text. Many participants felt they would not have time to read a text-based website, and some suggested that more interactive or engaging content, including audio and video, may be preferable. Most participants felt that the overall concept of Germ Defence was clearly relevant to their context. Some felt that it might be a useful introduction for new staff or refresher for current staff, but others felt that it did not add anything to their existing IPC training. There were mixed opinions about the level of detail provided in the information offered by the site. While the goal-setting behaviour change mechanism may have potential, findings suggested it may be unsuitable for care homes and more work would be needed to refine it. CONCLUSIONS Much more work needs to be done to make Germ Defence more engaging, accessible and relevant to the care home workforce. Our study highlights the challenges of rapidly adapting an existing intervention to a new context. Future research in this area would require a pragmatic methodological approach with a focus on implementation.