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. 2024 Dec 2;5(1):136.
doi: 10.1186/s43058-024-00669-7.

"You know, it feels like you can trust them": mixed methods implementation research to inform the scale up of a health disparities-responsive COVID-19 school testing program

Susan M Kiene  1 , Amanda P Miller  2 , Doreen Tuhebwe  2 , Diego A Ceballos  3   4 , Cynthia N Sanchez  5 , Jamie Moody  5 , Lynnette Famania  6 , Richard Vernon Moore  6 , Eyal Oren  2 , Corinne McDaniels-Davidson  2
Affiliations

"You know, it feels like you can trust them": mixed methods implementation research to inform the scale up of a health disparities-responsive COVID-19 school testing program

Susan M Kiene et al. Implement Sci Commun. .

Abstract

Background: Health disparities lead to negative COVID-19 outcomes for Hispanic/Latino communities. Rapid antigen testing was an important mitigation tool for protecting schools and their communities as in-person learning resumed. Within the context of a 3-middle-school non-inferiority trial we assessed acceptability and appropriateness of at-home and school-based COVID-19 antigen testing and implementation barriers and facilitators to facilitate district-wide scale up.

Methods: Guided by the Consolidated Framework for Implementation Research (CFIR) and acceptability and appropriateness implementation outcomes, we collected post-implementation qualitative (n = 30) and quantitative (n = 454) data in English and Spanish from trial participants, in-depth feedback sessions among program implementers (n = 19) and coded 137 project meeting minutes. Verbatim transcripts were thematically analyzed. We used multivariate linear models to evaluate program acceptability and appropriateness by COVID-19 testing modality and mixed qualitative and quantitative findings for interpretation.

Results: Questionnaire respondents closely matched school demographics (> 80% Hispanic/Latino and 8% Filipino/Asian Pacific Islander). While both testing modalities were rated as highly acceptable and appropriate, at-home testing was consistently favorable. Qualitative findings provided actionable areas for at-home testing program refinement, guiding district-wide scale up including: maintaining a learning climate to accommodate modifications as guidelines changed, needs of the school community, and implementation challenges; ensuring an engaged school leadership and sufficient human resources; improving educational communication about COVID-19 and technology ease of use; and increased time for pre-implementation planning and engagement.

Conclusions: Results underscore the value of the CFIR to inform program implementation, particularly programs to reduce disparities during a public health emergency. Results support optimal testing implementation strategies centering the needs and perspectives of Hispanic/Latinos.

Keywords: At-home testing; COVID-19; Consolidated Framework for Implementation Research; Health disparities; Hispanic/Latino; Implementation science; Middle school.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the San Diego State University Institutional Review Board (IRB #HS-2021–0208). Written informed consent and child assent/parental consent were obtained from all individual participants included in the study. Consent for publication: N/A. Competing interests: CM has received compensation as a consultant for Gilead Scientific. In addition, her spouse is employed by QuidelOrtho Corporation and has participated in their employee stock purchase program. The other authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
Implementation staffing structure. Assistant Principal or Principal was the contact person at each school. *CHWs—Community Health Workers
Fig. 2
Fig. 2
Acceptability items implementation outcomes for middle school COVID-19 testing programs: school-based vs. at-home testing. Notes: At home vs. school-based multivariate test: F11,435 = 5.72, p < 0.001, η2 0.13. Hispanic/Latino vs Non-Hispanic/Latino multivariate test: F11,435 = 1.54, p = 0.12. All individual item comparisons from the multivariate model between at-home and school-based testing significant at p < 0.001, η2 ranging from 0.06 to 0.10. Individual item comparisons for Hispanic/Latino vs Non-Hispanic/Latino not significantly different except “welcome the testing program,” B = -0.19, t = -2.10, p = 0.04, η2 0.01. No statistically significant interaction between testing modality and ethnicity
Fig. 3
Fig. 3
Appropriateness items implementation outcomes for middle school COVID-19 testing programs: school-based vs. at-home testing. Notes: At home vs. school-based multivariate test: F11,435 = 5.72, p < 0.001, η2 0.13. Hispanic/Latino vs Non-Hispanic/Latino multivariate test: F11,435 = 1.54, p = 0.12. All individual item comparisons from the multivariate model between at-home and school-based testing significant at p < 0.001, partial eta squares ranging from 0.07 to 0.10. Individual item comparisons for Hispanic/Latino vs Non-Hispanic/Latino all significantly different: B = -0.20, t = -2.13, p = 0.03, η2 0.01; B = -0.27, t = -2.95, p < 0.01, η2 0.02; B = -0.24, t = -2.71, p = 0.01, η2 0.02; B = -0.21, t = -2.23, p = 0.03, η2 0.01 for items in Fig. 3 respectively. No statistically significant interaction between testing modality and ethnicity
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