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A Web-Based Intervention (Germ Defence) to Increase Handwashing During a Pandemic: Process Evaluations of a Randomized Controlled Trial and Public Dissemination.
Miller, Sascha; Ainsworth, Ben; Weal, Mark; Smith, Peter; Little, Paul; Yardley, Lucy; Morrison, Leanne.
  • Miller S; Center for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom.
  • Ainsworth B; Bath Centre for Mindfulness and Compassion, Department of Psychology, University of Bath, Bath, United Kingdom.
  • Weal M; Web and Internet Science Group, Electronics and Computer Science, University of Southampton, Southampton, United Kingdom.
  • Smith P; Department of Social Statistics and Demography, School of Economic, Social and Political Scientces, University of Southampton, Southampton, United Kingdom.
  • Little P; Primary Care and Population Sciences, School of Medicine, University of Southampton, Southampton, United Kingdom.
  • Yardley L; Center for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom.
  • Morrison L; Centre for Academic Primary Care, School of Psychological Science, University of Bristol, Bristol, United Kingdom.
J Med Internet Res ; 23(10): e26104, 2021 10 05.
Article in English | MEDLINE | ID: covidwho-1463394
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. TRIAL REGISTRATION ISRCTN Registry ISRCTN75058295; https//www.isrctn.com/ISRCTN75058295.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Internet-Based Intervention / COVID-19 Type of study: Experimental Studies / Randomized controlled trials Limits: Humans Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2021 Document Type: Article Affiliation country: 26104

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Internet-Based Intervention / COVID-19 Type of study: Experimental Studies / Randomized controlled trials Limits: Humans Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2021 Document Type: Article Affiliation country: 26104