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.

Objectives: 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.

Note: Funding Statement: This work was supported by National Institute for Health Research (NIHR), Asthma UK and the British Lung Foundation, as a part of the CONDOR study. PK, MM, AM, and PB are supported by the NIHR London In Vitro Diagnostics Co-operative; AG is funded in part by the NIHR Applied Research Collaboration-East Midlands (ARC-EM). The views expressed are those of the authors and not necessarily those of the funders, the NHS, the NIHR or the Department of Health and Social Care.

Declaration of Interests: PK, MM, AM, ALG, and PB have nothing to declare. JSPT has been contracted to provide epidemiological support to Liverpool City Council during the COVID-19 pandemic. PP is employed by Liverpool City Council.

Ethics Approval Statement: This study was approved as a service evaluation as part of the wider CONDOR (COVID-19 National DiagnOstic Research and Evaluation Platform) initiative. This was approved as a Service Evaluation by Imperial College Healthcare NHS Trust (ICHNT)—registration no. 471. All participants were fully informed and consented to their involvement in the study. Participants were aware that they could withdraw from the study at any time.

Keywords: lateral flow devices, antigen test, SARS-CoV-2, nursing homes, residential homes, care homes