Garad Yasmin, Manea Andreea A, Pak Negin, Danok Lames, Baral Stefan, Dykstra Tom, Kasperavicius Danielle, Straus Sharon E, Fahim Christine
Knowledge Translation Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States.
Front Public Health. 2025 Apr 7;13:1560131. doi: 10.3389/fpubh.2025.1560131. eCollection 2025.
Point of care multiplex rapid antigen testing (RAT) is a tool that can be used to mitigate and respond to facility-based infectious disease outbreaks. However, little is known about how to optimally implement this testing in congregate living settings (CLSs), including long term care homes (LTCHs), retirement homes (RHs), and shelters serving people experiencing homelessness. Our objective was to explore the barriers and facilitators to implementing a new device for multiplex RAT for COVID-19 and influenza across CLSs in the Greater Toronto Area, Canada.
Using key informant interviews, we assessed barriers and facilitators to implementing multiplex RAT across CLSs. Qualitative coding using the framework approach was used to identify themes. We used the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR) to identify individual and contextual-level barriers and facilitators to implementation. Identified barriers were then mapped to implementation strategies using theoretically-rooted frameworks and tools.
We completed 45 interviews with staff at CLSs (8 LTCHs, 4 RHs, 12 shelters) between January 2022 and March 2023. Four barriers to RAT implementation in CLSs emerged including: limited material resources for implementation; insufficient staff capacity to perform RAT testing; complexity of RAT implementation; and reluctance among staff to adopt a new testing process. Five facilitators to implementation were described including: training and implementation support for staff at the CLSs; site-level implementation champions; access to materials to support testing; perceived advantages of simultaneous testing for COVID-19 and influenza; and the usability and functionality of the RAT testing device. Twenty implementation strategies were identified through implementation strategy mapping.
Multiplex RAT options can empower CLS staff to promptly identify and respond to viral respiratory outbreaks. The use of evidence-based implementation strategies can enhance the effectiveness of using multiplex RAT to control outbreaks in CLSs.
即时护理多重快速抗原检测（RAT）是一种可用于缓解和应对医疗机构内传染病暴发的工具。然而，对于如何在集体生活环境（CLS）中最佳地实施这种检测，我们知之甚少，这些环境包括长期护理院（LTCH）、养老院（RH）以及为无家可归者提供服务的庇护所。我们的目标是探讨在加拿大多伦多地区的集体生活环境中实施一种用于新冠病毒和流感的新型多重RAT检测设备的障碍和促进因素。
通过关键信息人访谈，我们评估了在集体生活环境中实施多重RAT检测的障碍和促进因素。使用框架方法进行定性编码以识别主题。我们使用理论领域框架（TDF）和实施研究综合框架（CFIR）来识别实施过程中个人层面和背景层面的障碍与促进因素。然后，使用基于理论的框架和工具将识别出的障碍映射到实施策略上。
在2022年1月至2023年3月期间，我们对集体生活环境中的工作人员（8家长期护理院、4家养老院、12个庇护所）进行了45次访谈。在集体生活环境中实施RAT检测出现了四个障碍，包括：实施所需的物质资源有限；进行RAT检测的工作人员能力不足；RAT实施的复杂性；以及工作人员不愿采用新的检测流程。描述了五个实施促进因素，包括：为集体生活环境中的工作人员提供培训和实施支持；机构层面的实施倡导者；获取支持检测的材料；同时检测新冠病毒和流感的感知优势；以及RAT检测设备的可用性和功能。通过实施策略映射确定了20种实施策略。
多重RAT检测选项可以使集体生活环境的工作人员能够迅速识别并应对病毒性呼吸道疾病暴发。使用基于证据的实施策略可以提高利用多重RAT检测控制集体生活环境中疾病暴发的有效性。
