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

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)

Predictors of SARS-CoV-2 Infection in University Students: A Case-Control Study

“…On the other hand, the prolonged closure of HEIs has led to a worsening of student performance [ 9 ] and of their mental health and well-being [ 10 ], suggesting that the closure of face-to-face teaching activities cannot be considered a sustainable measure in the long term. As a consequence, when they reopened in the fall of 2020, numerous universities enacted various mitigation measures to prevent campus outbreaks and to avoid further interruptions to in-person teaching activities [ 6 , 11 ]. Nevertheless, evidence of HEIs as enhancers of SARS-CoV-2 spread is sparse and mixed.…”

A Qualitative Evaluation of the Barriers and Enablers for Implementation of an Asymptomatic SARS-CoV-2 Testing Service at the University of Nottingham: A Multi-Site Higher Education Setting in England

“…Over a two-year period, the University’s ATS tested over 150,000 samples for SARS-CoV-2 RNA, identifying almost 2000 positive cases in staff and students who displayed no symptoms of COVID-19 at the time of testing. Further details about service provision from pilot stage to rollout of the full service are provided elsewhere [ 28 , 30 ]. Details of the ATS delivery and timeline, within the changing pandemic context, are provided in Figure 1 .…”

“…Some studies have investigated students’ views towards the service, or established testing acceptability among service users [ 27 , 28 , 29 ]. A recent study explored the facilitators and barriers to the implementation of SARS-CoV-2 testing in a university setting [ 30 ]. This was a mixed-methods process evaluation of the University of Nottingham asymptomatic testing service (ATS), investigating adherence to a specific residence-based testing protocol and the views of students and staff towards the service offer, after 7–8 months of service operation.…”

Workforce Experiences of a Rapidly Established SARS-CoV-2 Asymptomatic Testing Service in a Higher Education Setting: A Qualitative Study

“…Universities across the world have implemented mitigation strategies for managing SARS-CoV-2 transmission associated with higher education, including strategies for assessment of risk in certain environments (e.g., student households, teaching and learning facilities, social environments), phased re-openings, behavioural and environmental interventions, testing, contact tracing and support for social isolation (e.g., [13][14][15][16][17][18]). One mitigation approach is routine surveillance testing for asymptomatic persons on university campuses, which, in combination with behaviour-based interventions, has shown to be feasible, acceptable [19][20][21][22] and successful in identifying infections, halting or reducing onward transmission and reducing total caseload [15,[23][24][25][26].…”