Technology-enabled CONTACT tracing in care homes in the COVID-19 pandemic: the CONTACT non-randomised mixed-methods feasibility study
Background Coronavirus disease 2019 devastated lives in care homes for older people, where residents faced higher mortality risks than the general population. Infection prevention and control decisions were critical to protect these vulnerable residents. Infection prevention and control measures lik...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
NIHR Journals Library
2025-05-01
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| Series: | Health Technology Assessment |
| Subjects: | |
| Online Access: | https://doi.org/10.3310/UHDN6497 |
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| Summary: | Background Coronavirus disease 2019 devastated lives in care homes for older people, where residents faced higher mortality risks than the general population. Infection prevention and control decisions were critical to protect these vulnerable residents. Infection prevention and control measures like ‘lockdowns’ had their own risks, such as social isolation, alongside assumed benefits. A key non-pharmaceutical intervention for managing infections is contact tracing. Traditional contact tracing, which relies on recalling contacts, is not feasible in care homes where approximately 70% of residents have cognitive impairments. The CONtact TrAcing in Care homes using digital Technology intervention introduces Bluetooth-enabled wearable devices for automated contact tracing. We provided structured reports (scheduled regularly and in reaction to positive COVID-19 cases) on contact patterns to homes to support better-informed infection prevention and control decisions and potentially reduce blanket restrictive measures. We also partnered with the PROTECT COVID-19 research team to examine air quality in two of our homes. Methods CONTACT was a non-randomised mixed-method feasibility study in four English care homes. Recruitment was via care home research networks, with individual consent. Data collection included routine device data, case report forms, qualitative interviews, field observations of care home activity and an adapted Normalisation Measure Development questionnaire survey to explore implementation using normalisation process theory. Quantitative data were analysed using descriptive statistical methods, and qualitative data were thematically analysed using normalisation process theory. Intervention and study delivery were evaluated against predefined progression criteria. Results Of 156 eligible residents, 105 agreed to wear a device, with 102 (97%) starting the intervention. Of 225 eligible staff, 82.4% (n = 178) participated. Over 2 months, device loss and battery failure were significant: residents lost 11% of devices, with half replaced. Staff lost fewer devices, just 6.5%, but < 10% were replaced. Fob wearables needed more battery changes than card-type devices (15% vs. 0%). Homes variably understood structured and reactive feedback but were unlikely to act on it. Researcher support for interpreting reports was valued. Homes found information useful when it confirmed rather than challenged preconceived contact patterns. Staff privacy concerns were a barrier to adoption. Study procedures added to existing work, making participation burdensome. The perceived burden of participation, amplified by the pandemic context, outweighed the benefits. CONTACT did not meet its quantitative or qualitative progression criteria. Limitations Researchers had to pragmatically adapt procedures, resulting in suboptimal implementation choices from an implementation science perspective. Future research should co-design interventions with homes, focusing on implementation and wearability as much as technical effectiveness. Conclusion A definitive trial of CONTACT was not feasible or acceptable to care homes, partly due to the shifting pandemic context and demands on homes. With more effective implementation, Bluetooth-enabled wearable systems as part of ‘Internet of Things’ in homes could be used to: (1) better understand airborne transmission risks, ventilation and air quality and (2) make important relational aspects of care quality and residents’ quality of life more transparent. Future work We will continue to explore the possibilities of Bluetooth-enabled wearables for modelling social networks, movement, infection risks and quality in care homes with academic and care partners. Funding This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR132197.
Plain language summary Why did we do this study? Care home residents and staff were at high risk during the coronavirus disease pandemic. Lockdowns had uncertain benefits and increased risks of isolation and loneliness. Traditional contact tracing is challenging in care homes due to residents’ memory issues and staff’s unavoidable contacts. We developed ‘CONtact TrAcing in Care homes using digital Technology’, a system using bluetooth-enabled wearables (BLE wearables) worn by residents and staff to collect data on who is most at risk, potential infection hotspots, and the effectiveness of infection control. For CONtact TrAcing in Care homes using digital Technology to be effective, it needed to be reliable and acceptable, with homes acting on the information. Before conducting a large study comparing homes with and without CONtact TrAcing in Care homes using digital Technology, we first assessed its feasibility and acceptability. What did we do? Between November 2021 and April 2022, 202 residents and 158 staff in four care homes in North and West Yorkshire, United Kingdom, wore bluetooth-enabled wearables for 2 months. We collected information on their perceptions of the technology, how they used it, infections in the homes, and changes in work practices. We simulated the technology’s use to examine factors affecting performance, such as device usage and building materials. We also partnered with the PROTECT COVID-19 study to measure air quality in two homes. What did we find? CONtact TrAcing in Care homes using digital Technology was not ready to progress to a large randomised study. While effective in controlled conditions, implementation was too varied and unreliable. Trust issues and privacy concerns among staff reduced confidence in CONtact TrAcing in Care homes using digital Technology. The burden of participation outweighed the usefulness of the feedback provided. What does this mean for people who live and work in care homes? Bluetooth-enabled wearables for contact tracing could still be helpful but need to be more acceptable and provide more useful information. Researchers should collaborate with care homes to improve the experience of using bluetooth-enabled wearables, enhance understanding of infection risks, and minimise research burden. |
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| ISSN: | 2046-4924 |