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. 2023 Jan 5:10:1024525.
doi: 10.3389/fpubh.2022.1024525. eCollection 2022.

From disgusting and complicated to simple and brilliant: Implementation perspectives and lessons learned from users and rejectors of mail-in SARS-CoV-2 gargle tests

Freda Röhr  1 , Ferdinand Uellner  1 , Andreas Deckert  1 , Simon Anders  2   3 , Robin Burk  2 , Michael Knop  2   4 , Lucia Brugnara  5 , Till Bärnighausen  1 , Albrecht Jahn  1 , Shannon McMahon  1   6 , Aurélia Souares  1   7
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From disgusting and complicated to simple and brilliant: Implementation perspectives and lessons learned from users and rejectors of mail-in SARS-CoV-2 gargle tests

Freda Röhr et al. Front Public Health. .

Abstract

Background: Despite the important role of testing as a measure against the COVID-19 pandemic, user perspectives on SARS-CoV-2 tests remain scarce, inhibiting an improvement of testing approaches. As the world enters the third year of the pandemic, more nuanced perspectives of testing, and opportunities to expand testing in a feasible and affordable manner merit consideration.

Methods: Conducted amid the second pandemic wave (late 2020-early 2021) during and after a multi-arm trial evaluating SARS-CoV-2 surveillance strategies in the federal state Baden-Württemberg, Germany, this qualitative sub-study aimed to gain a deeper understanding of how test users and test rejectors perceived mail-in SARS-CoV-2 gargle tests. We conducted 67 semi-structured in-depth interviews (mean duration: 60 min) via telephone or video call. Interviews were audio-recorded, transcribed verbatim and analyzed inductively using thematic analysis. The Consolidated Framework for Implementation Research guided the findings' presentation.

Results: Respondents generally described gargle sampling as simple and comfortable. However, individual perceptions of the testing method and its feasibility varied widely from disgusting and complicated to simple and brilliant. Self-sampling was appreciated for lowering infection risks during testing, but also considered more complex. Gargle-sampling increased participants' self-efficacy to sample correctly. Communication (first contact, quantity and content of information, reminders, support system) and trust (in the study, its institutional affiliation and test method) decisively influenced the intervention's acceptability.

Conclusion: User-driven insights on how to streamline testing include: consider communication, first impressions of tests and information as key for successful mail-in testing; pay attention to the role of mutual trust between those taking and administering tests; implement gargle self-sampling as a pleasant alternative to swab testing; offer multiple test methods to increase test up-take.

Keywords: COVID-19; SARS-CoV-2; gargle test; implementation study; mail-in tests; self-sampling; test rejector perspectives; test user perspectives.

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Conflict of interest statement

LB was employed Evaplan Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Self-sampling material: Small bottle containing saline solution, straw, test tube.
Figure 2
Figure 2
Package received by participants: Shipping carton; protective plastic cover with yellow, liquid-absorbing fleece; plastic bag with testing material.
See this image and copyright information in PMC

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