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Process evaluations of a web-based intervention to increase handwashing during a pandemic: Moving Germ Defence from a randomised controlled trial to public dissemination

Process evaluations of a web-based intervention to increase handwashing during a pandemic: Moving Germ Defence from a randomised controlled trial to public dissemination
Process evaluations of a web-based intervention to increase handwashing during a pandemic: Moving Germ Defence from a randomised controlled trial to public dissemination

Background: Washing hands helps prevent transmission of seasonal and pandemic respiratory viruses. In a randomized controlled trial (RCT) during the swine flu outbreak, participants with access to a fully automated, digital intervention promoting handwashing reported washing their hands more often and experienced fewer respiratory tract infections than those without access to the intervention. Based on these findings, the intervention was adapted, renamed as "Germ Defence," and a study was designed to assess the preliminary dissemination of the intervention to the general public to help prevent the spread of seasonal colds and flu. Objective: This study compares the process evaluations of the RCT and Germ Defence dissemination to examine (1) how web-based research enrollment procedures affected those who used the intervention, (2) intervention usage in the 2 contexts, and (3) whether increased intentions to wash hands are replicated once disseminated. Methods: The RCT ran between 2010 and 2012 recruiting participants offline from general practices, with restricted access to the intervention (N=9155). Germ Defence was disseminated as an open access website for use by the general public from 2016 to 2019 (N=624). The process evaluation plan was developed using Medical Research Council guidance and the framework for Analyzing and Measuring Usage and Engagement Data. Both interventions contained a goal-setting section where users self-reported current and intended handwashing behavior across 7 situations. Results: During web-based enrolment, 54.3% (17,511/32,250) of the RCT participants dropped out of the study compared to 36.5% (358/982) of Germ Defence users. Having reached the start of the intervention, 93.8% (8586/9155) of RCT users completed the core section, whereas 65.1% (406/624) of Germ Defence users reached the same point. Users across both studies selected to increase their handwashing in 5 out of 7 situations, including before eating snacks (RCT mean difference 1.040, 95% CI 1.016-1.063; Germ Defence mean difference 0.949, 95% CI 0.766-1.132) and after blowing their nose, sneezing, or coughing (RCT mean difference 0.995, 95% CI 0.972-1.019; Germ Defence mean difference 0.842, 95% CI 0.675-1.008). Conclusions: By comparing the preliminary dissemination of Germ Defence to the RCT, we were able to examine the potential effects of the research procedures on uptake and attrition such as the sizeable dropout during the RCT enrolment procedure that may have led to a more motivated sample. The Germ Defence study highlighted the points of attrition within the intervention. Despite sample bias in the trial context, the intervention replicated increases in intentions to handwash when used "in the wild." This preliminary dissemination study informed the adaptation of the intervention for the COVID-19 health emergency, and it has now been disseminated globally.

Behavior, COVID-19, Digital intervention, Dissemination, Evaluation studies, Infection, Influenza, Internet, Intervention, Pandemic, Prevention, Respiratory, Respiratory tract infection, Transmission, Virus
1438-8871
Miller, Sascha
448d724f-ce7d-4e8e-9ff1-e0255e995c77
Ainsworth, Benjamin
b02d78c3-aa8b-462d-a534-31f1bf164f81
Weal, Mark
e8fd30a6-c060-41c5-b388-ca52c81032a4
Smith, Peter W.F.
961a01a3-bf4c-43ca-9599-5be4fd5d3940
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Morrison, Leanne
920a4eda-0f9d-4bd9-842d-6873b1afafef
Miller, Sascha
448d724f-ce7d-4e8e-9ff1-e0255e995c77
Ainsworth, Benjamin
b02d78c3-aa8b-462d-a534-31f1bf164f81
Weal, Mark
e8fd30a6-c060-41c5-b388-ca52c81032a4
Smith, Peter W.F.
961a01a3-bf4c-43ca-9599-5be4fd5d3940
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Morrison, Leanne
920a4eda-0f9d-4bd9-842d-6873b1afafef

Miller, Sascha, Ainsworth, Benjamin, Weal, Mark, Smith, Peter W.F., Little, Paul, Yardley, Lucy and Morrison, Leanne (2021) Process evaluations of a web-based intervention to increase handwashing during a pandemic: Moving Germ Defence from a randomised controlled trial to public dissemination. Journal of Medical Internet Research, 23 (10), [e26104]. (doi:10.2196/26104).

Record type: Article

Abstract

Background: Washing hands helps prevent transmission of seasonal and pandemic respiratory viruses. In a randomized controlled trial (RCT) during the swine flu outbreak, participants with access to a fully automated, digital intervention promoting handwashing reported washing their hands more often and experienced fewer respiratory tract infections than those without access to the intervention. Based on these findings, the intervention was adapted, renamed as "Germ Defence," and a study was designed to assess the preliminary dissemination of the intervention to the general public to help prevent the spread of seasonal colds and flu. Objective: This study compares the process evaluations of the RCT and Germ Defence dissemination to examine (1) how web-based research enrollment procedures affected those who used the intervention, (2) intervention usage in the 2 contexts, and (3) whether increased intentions to wash hands are replicated once disseminated. Methods: The RCT ran between 2010 and 2012 recruiting participants offline from general practices, with restricted access to the intervention (N=9155). Germ Defence was disseminated as an open access website for use by the general public from 2016 to 2019 (N=624). The process evaluation plan was developed using Medical Research Council guidance and the framework for Analyzing and Measuring Usage and Engagement Data. Both interventions contained a goal-setting section where users self-reported current and intended handwashing behavior across 7 situations. Results: During web-based enrolment, 54.3% (17,511/32,250) of the RCT participants dropped out of the study compared to 36.5% (358/982) of Germ Defence users. Having reached the start of the intervention, 93.8% (8586/9155) of RCT users completed the core section, whereas 65.1% (406/624) of Germ Defence users reached the same point. Users across both studies selected to increase their handwashing in 5 out of 7 situations, including before eating snacks (RCT mean difference 1.040, 95% CI 1.016-1.063; Germ Defence mean difference 0.949, 95% CI 0.766-1.132) and after blowing their nose, sneezing, or coughing (RCT mean difference 0.995, 95% CI 0.972-1.019; Germ Defence mean difference 0.842, 95% CI 0.675-1.008). Conclusions: By comparing the preliminary dissemination of Germ Defence to the RCT, we were able to examine the potential effects of the research procedures on uptake and attrition such as the sizeable dropout during the RCT enrolment procedure that may have led to a more motivated sample. The Germ Defence study highlighted the points of attrition within the intervention. Despite sample bias in the trial context, the intervention replicated increases in intentions to handwash when used "in the wild." This preliminary dissemination study informed the adaptation of the intervention for the COVID-19 health emergency, and it has now been disseminated globally.

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PRIMIT and Germ Defence process evaluations - Accepted Manuscript
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Accepted/In Press date: 31 May 2021
Published date: 5 October 2021
Keywords: Behavior, COVID-19, Digital intervention, Dissemination, Evaluation studies, Infection, Influenza, Internet, Intervention, Pandemic, Prevention, Respiratory, Respiratory tract infection, Transmission, Virus

Identifiers

Local EPrints ID: 451561
URI: http://eprints.soton.ac.uk/id/eprint/451561
ISSN: 1438-8871
PURE UUID: fbe097cf-e2da-4adc-8255-f5234472d26c
ORCID for Sascha Miller: ORCID iD orcid.org/0000-0002-1949-5774
ORCID for Benjamin Ainsworth: ORCID iD orcid.org/0000-0002-5098-1092
ORCID for Mark Weal: ORCID iD orcid.org/0000-0001-6251-8786
ORCID for Peter W.F. Smith: ORCID iD orcid.org/0000-0003-4423-5410
ORCID for Paul Little: ORCID iD orcid.org/0000-0003-3664-1873
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X
ORCID for Leanne Morrison: ORCID iD orcid.org/0000-0002-9961-551X

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Date deposited: 11 Oct 2021 16:30
Last modified: 12 Jul 2024 04:02

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Contributors

Author: Sascha Miller ORCID iD
Author: Benjamin Ainsworth ORCID iD
Author: Mark Weal ORCID iD
Author: Paul Little ORCID iD
Author: Lucy Yardley ORCID iD
Author: Leanne Morrison ORCID iD

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