Implementation of a volunteer contact tracing program for COVID-19 in the United States: A qualitative focus group study

Abstract

Background Contact tracing is an important tool for suppressing COVID-19 but has been difficult to adapt to the conditions of a public health emergency. This study explored the experiences and perspectives of volunteer contact tracers in order to identify facilitators, challenges, and novel solutions for implementing COVID-19 contact tracing. Methods As part of a study to evaluate an emergently established volunteer contact tracing program for COVID-19 in New Haven, Connecticut, April-June 2020, we conducted focus groups with 36 volunteer contact tracers, thematically analyzed the data, and synthesized the findings using the RE-AIM implementation framework. Results To successfully reach cases and contacts, participants recommended identifying clients’ outreach preferences, engaging clients authentically, and addressing sources of mistrust. Participants felt that the effectiveness of successful isolation and quarantine was contingent on minimizing delays in reaching clients and on systematically assessing and addressing their nutritional, financial, and housing needs. They felt that successful adoption of a volunteer-driven contact tracing model depended on the ability to recruit self-motivated contact tracers and provide rapid training and consistent, supportive supervision. Participants noted that implementation could be enhanced with better management tools, such as more engaging interview scripts, user-friendly data management software, and protocols for special situations and populations. They also emphasized the value of coordinating outreach efforts with other involved providers and agencies. Finally, they believed that long-term maintenance of a volunteer-driven program requires monetary or educational incentives to sustain participation. Conclusions This is one of the first studies to qualitatively examine implementation of a volunteer-run COVID-19 contact tracing program. Participants identified facilitators, barriers, and potential solutions for improving implementation of COVID-19 contact tracing in this context. These included standardized communication skills training, supportive supervision, and peer networking to improve implementation, as well as greater cooperation with outside agencies, flexible scheduling, and volunteer incentives to promote sustainability.

Lessons Learned From COVID-19 Contact Tracing During a Public Health Emergency: A Prospective Implementation Study

“…Bundling interventions to enhance impact is critical to solve what might be described as the pandemic's “Swiss cheese” problem, in which holes in the clinical and public health response arise at multiple levels, times, and locations to sustain the pandemic ( 42 ). Qualitative data collected in parallel with this project and published separately ( 41 ) supports this idea that even if contact tracing itself has gaps, it may still contribute to the overall public health response. Limited retrospective data from other settings also suggests that contact tracing may also contribute to improved cumulative outcomes ( 7 ), and this important question should be evaluated further in future prospective studies.…”

“…In evaluating Adoption , we found volunteers to be a feasible, although not sustainable, solution to human resource shortages, given the high turnover among volunteers. We separately conducted focus groups with volunteers, described in detail elsewhere ( 41 ), who reported that burnout and transitions in academic roles and schedules likely contributed to decreased volunteer availability. Fortunately, the support of public health nurses bolstered capacity during surges and sustained the program.…”

“…First, missing demographic data may have biased our analyses in uncertain ways, but we used multiple imputation to help reduce such biases in our models. Second, we did not capture the reasons for unanswered calls, or for refusals to participate, although the viewpoints and experiences of volunteer contacts are presented in detail elsewhere ( 41 ), and separate studies will report the viewpoints of cases and contacts regarding these and other barriers to uptake. Third, we could not evaluate under-reporting of contacts and therefore may have overestimated the proportion of contacts reached.…”

The Containment Scouts: First Insights into an Initiative to Increase the Public Health Workforce for Contact Tracing during the COVID-19 Pandemic in Germany

“…In the USA, several academic public health programmes and schools trained students as contact tracers in response to COVID-19 [18]. Community-based partnerships between universities and local health departments were established to compensate for workforce shortages [19][20][21]. These programmes were mostly volunteer-based [19,20,22,23], and students received academic credit and work experience in return [20,22].…”

Appraisal of a Contact Tracing Training Program for COVID-19 in Greece Focusing on Vulnerable Populations

“…The ability to quickly expand quality services to meet demand has emerged as a problem in need of innovative solutions that will be crucial in the current, but also possible future, pandemics. Different models have been employed to address this need, from the use of digital technology to recruitment of furloughed staff, health sciences students and volunteer led services in the US and elsewhere [39][40][41][42][43][44][45].…”