Implementing lateral flow devices in long-term care facilities: experiences from the Liverpool COVID-19 community testing pilot in care homes— a qualitative study

Abstract

Introduction Antigen-based lateral flow devices (LFDs) offer the potential of widespread rapid testing. The scientific literature has primarily focused on mathematical modelling of their use and test performance characteristics. For these tests to be implemented successfully, an understanding of the real-world contextual factors that allow them to be integrated into the workplace is vital. To address this gap in knowledge, we aimed to explore staff’s experiences of integrating LFDs into routine practice for visitors and staff testing with a view to understand implementation facilitators and barriers. Methods Semi-structured interviews and thematic analysis. Results We identified two main themes and five subthemes. The main themes included: visitor-related testing factors and staff-related testing factors. Subthemes included: restoring a sense of normality, visitor-related testing challenges, staff-related testing challenges, and pre-pilot antecedent factors. Conclusion Our study demonstrates that the real-world implementation of LFDs to test visitors and staff faces significant challenges as a result of several contextual factors negatively affecting the work practice and environment. More comprehensive studies are needed to identify and inform effective implementation strategies to ensure that LFDs can be adopted in an agile way that better supports an already exhausted and morally depleted workforce.

Who is engaging with lateral flow testing for COVID-19 in the UK? The COVID-19 Rapid Survey of Adherence to Interventions and Responses (CORSAIR) study

“…Qualitative research suggests that barriers to implementing testing in the workplace include perceived inaccuracy of LFTs and adding to employee burden. 28 There are also ethical issues to consider in employers putting pressure on their employees, and there is a potential resulting lack of income if workers are unable to attend their place of work if they decline. 29 Mandating testing may result in negative attitudes toward testing becoming more entrenched.…”

Exploration of the uptake of asymptomatic COVID-19 lateral flow testing in Birmingham, UK: survey and qualitative research

“…Other studies examining perspectives on LFT accuracy also demonstrate that individuals give varied estimates of the accuracy of these tests11 or express uncertainty about their accuracy 12 13. In a study of care home staff experiences of integrating LFTs in routine practice participants were worried about the implications of inaccurate results such as false positives 14. For some participants in our study, this was sufficient to influence decisions to not test, with concerns expressed in interviews regarding the individual and societal implications of false-positive and false-negative test results.…”

“…Elsewhere university students have given positive feedback about regular asymptomatic testing but also expressed a desire for reminders to do so 11. In care homes, staff have been concerned about the additional impacts and stressors related to testing,14 and testing regimes were not well adhered to in a pilot scheme 17. In secondary school households, approximately 10% of respondents stated that nobody including school children were testing; 16% when including all school households.…”

A systematic review on rapid antigen test devices for SARS-CoV-2 in nursing homes: Useful, but handle with care

“…The COVID-19 pandemic has disproportionately affected Nursing homes (NHs), with mortality rates largely exceeding those of the general population, particularly during the first wave. 1 , 2 A recent study from England and Wales has estimated an 18-fold difference in mortality rates when figures were compared to the pre-pandemic time period, but this is a likely an underestimate given the low levels of testing in NHs, particularly when nasal swabs with subsequent Real-Time quantitative polymerase chain reaction (RT-qPCR) represented the only validated diagnostic items. 2 …”

“…Indeed, RAT may be quite unreliable when employed to screen earlier stages of SARS-CoV-2 infections, or in individuals who, because of their even transitory lack of symptoms, may actively spread the infection not only among other residents, but also in NH workers failing to cope with appropriate preventive measures. 1 , 2 As a consequence, as suggested by McKay et al, 9 early and frequent referral to RAT rather than a single and synchronous sampling campaign may be quite effective in identifying individuals with the greatest potential to transmit the virus.…”