Introduction
Method
GPs’ requirements | Design strategies adopted |
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Swabber protection Swabbers should be protected from droplets produced by coughing and sneezing during swabbing. | • A full-height cubicle served as a barrier between patient and swabber, with a roof to block upward transmission trajectory. • The joints of the structure were sealed to prevent droplet transmission. |
Ease of disinfection Wipe-down had to be simple as the booth would be disinfected between patients. | • For the panels, polycarbonate was chosen over acrylic as polycarbonate could withstand wipe-downs with alcohol. • Surfaces were made as smooth as possible with no nooks and crannies. |
Outdoor or semi-outdoor use GPs should be able to place it outside the clinic to segregate swabbing space from consultation space, for infection control. | • Aluminium and polycarbonate were chosen for their weather-resistance. • No electrical components were included. • The cubicles were open, without doors, to allow wind, humidity, heat and sunlight to combat pathogens. This would also reduce the number of surfaces needing wipe-down between patients. |
Mobility In order to be stored indoors after hours, it had to be sufficiently compact to fit within small clinic spaces, and require minimal manpower to set up as GP clinics run on lean teams. | • Castors and handles were added. • It was made narrow enough to pass through standard doorways. • The footprint was made just large enough to contain both swabber and patient (600x800mm). • Lightweight materials and compact size made it easy for a single clinic staff to move and set up. |
Good ergonomics It should be comfortable for the swabber to perform the procedure. It should also accommodate patients of different builds. | • Dimensions were specified for a standing swabber performing a nasopharyngeal swab on a patient 1.10–1.75 m tall. Shorter patients could stand on a stool and taller patients could be seated. • Glove ports were fixed at a comfortable height for testers who were 1.55–1.75 m tall. • Gloves had to be touch-sensitive, low cost and easy to replace. • Curved shelves in both cubicles provided space for swabbing equipment to be placed. |
Patient privacy If the swabbing was done outside the clinic in a public area, patient privacy had to be respected. | • Semi-opaque cubicles for swabber and patient provided some privacy while allowing light to pass through for swabbing. |
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Idea generation: CMC translated the GP testers’ inputs into a design drawing.
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Prototyping: ATC built a prototype based on the design drawing.
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Testing: The completed prototypes were tested on-site in CMC. GP testers role-played as swabber and patient, performing pretend swabs to test booth ergonomics, and provided feedback. Patients were not involved in testing at this stage.
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Observation: TF and CMC consolidated the feedback. Design decisions were then translated into a final design drawing. Table 1 summarises the design strategies.
Results
Characteristics of the respondents and their practices
n (%) | Mean (SD) | |
---|---|---|
Age | ||
30–39 | 23 (25%) | – |
40–49 | 28 (30%) | – |
50–59 | 35 (38%) | – |
60–69 | 6 (6%) | – |
70 and above | 1 (1%) | – |
Type of practice | – | |
Solo clinic | 45 (48%) | – |
Group of 2–9 clinics | 31 (33%) | – |
Group of 10 or more clinics | 17 (18%) | – |
Number of doctors in clinic | – | 1.95 (1.20) |
Number of clinic support staff | – | 4.52 (2.68) |
Location of GP clinic | ||
public residential estate | 70 (75%) | – |
shopping mall | 13 (14%) | – |
private residential estate | 4 (5%) | – |
office building | 5 (5%) | – |
industrial estate | 1 (1%) | – |
Primary findings on user experience: reasons for booth application and booth satisfaction
n(%) | |
---|---|
Reasons for applying for booth (multiple selections accepted) | (n = 92) a |
I felt it would be safer for the swabber | 79 (86%) |
I felt it would make the disinfection process easier | 60 (65%) |
It was provided free of charge | 51 (55%) |
I did not have the necessary equipment to conduct a swab test (e.g. table, privacy screen) | 29 (32%) |
I felt it would provide privacy for the patients | 28 (30%) |
Other (reduced patient anxiety, save time without having to wear full PPE, wanted designated work area for swabbing outside clinic) | 4 (4%) |
Are you currently using the booth to conduct swab tests? | (n = 86) a |
Yes | 68 (79%) |
No, I swab without the booth now | 16 (19%) |
No, I have stopped conducting swab tests in my clinic | 2 (2%) |
How likely are you to recommend the booth to another colleague? | (n = 85) a |
Will strongly recommend | 34 (40%) |
Will recommend | 29 (34%) |
Neutral | 15 (18%) |
Will not recommend | 6 (7%) |
Strongly will not recommend | 1 (1%) |
What do you like about the booth? (multiple selections accepted) | (n = 87) a |
It provides protection to the swabber | 80 (92%) |
It creates a separate space for swabbing | 62 (71%) |
It makes the disinfection process easier and quicker | 56 (64%) |
It is easy to move around | 44 (51%) |
It is easy to conduct swab tests using the booth | 41 (47%) |
It provides privacy to the patient | 36 (41%) |
Others: | 2 (2%) |
What do you not like about the booth? (multiple selections accepted) | (n = 86) a |
Others (e.g. gloves, glove port height) | 38 (44%) |
Takes up too much space | 29 (34%) |
Difficult to conduct swab tests using the booth | 27 (31%) |
Difficult to disinfect | 14 (16%) |
Troublesome to set up and store | 14 (16%) |
Inadequate patient privacy | 12 (14%) |
Inadequate swabber protection | 1 (1%) |
Were you swabbing patients prior to receiving the booth? | (n = 92) a |
Yes | 49 (53%) |
No | 43 (47%) |
How important was getting the booth in your decision to participate in Swab-and-Send-Home (SASH)? | (n = 92) a |
Very important | 32 (35%) |
Important | 21 (23%) |
Somewhat important | 23 (25%) |
Not important | 16 (17%) |
Exploratory analyses of factors associated with user experience
Likes and dislikes correlated with continued booth use | |||
Currently swabbing with booth (n = 68) | Currently swabbing without booth (n = 16) | p-value | |
Likes: | |||
• It creates a separate space for swabbing | 53 (78%) | 7 (44%) | 0.006a |
• It is easy to move around | 38 (56%) | 4 (25%) | 0.026 |
• It is easy to conduct swab tests using the booth | 40 (59%) | 0 (0%) | < 0.001 |
• It provides protection for the swabber | 65 (96%) | 13 (81%) | 0.045a |
• It provides privacy to the patient | 33 (49%) | 3 (19%) | 0.030 |
• It makes the disinfection process easier and quicker | 47 (69%) | 7 (44%) | 0.057a |
Dislikes: | |||
• It takes up too much space | 18 (26%) | 10 (63%) | 0.006a |
• Difficult to conduct swab tests using the booth | 13 (19%) | 14 (88%) | < 0.001 |
• Difficult to disinfect | 10 (15%) | 4 (25%) | 0.320 |
• Troublesome to set up and store | 7 (10%) | 7 (44%) | 0.001a |
• Inadequate patient privacy | 7 (10%) | 4 (25%) | 0.117 |
• Inadequate swabber protection | 0 (0%) | 1 (6%) | 0.038a |
Commented on gloves | 22 (32%) | 4 (25%) | 0.567 |
Commented on glove ports | 9 (13%) | 4 (25%) | 0.242 |
Note. Chi-square tests of associations were performed for all analyses. Results in bold are statistically significant | |||
a some cells have expected count less than 5 | |||
Comparison of users < 50 years old and ≥ 50 years old | |||
< 50 years old (n = 50) | ≥50 years old (n = 42) | p-value | |
n (%) or Mean (SD) | |||
Currently using the booth | 36 (72%) | 32 (76%) | 0.252 |
Not swabbing prior to receiving booth | 18 (36%) | 25 (60%) | 0.024 |
Total number of likes | 3.45 (1.74) | 4.13 (1.34) | 0.044 |
Total number of dislikes | 1.47 (1.25) | 1.74 (1.33) | 0.326 |
How important was getting the booth to your decision to participate in SASH? (1 = not important; 4 = very important) | 2.64 (1.17) | 2.88 (1.04) | 0.305 |
How likely are you to recommend the booth? (1 = will strongly recommend; 5 = strongly will not recommend) | 2.04 (1.07) | 1.85 (0.88) | 0.361 |
Patterns of use
Users’ free text comments on booth design
Theme | Sub-theme | Examples |
---|---|---|
Gloves (35) | Prefer to swab without long gloves [9] | “I cut off the hands of the gloves as it was time consuming and difficult to use with the gloves” |
Wrong size [7] | “supplied gloves too small. Not used as a result.” | |
Not touch-sensitive enough [6] | “glooves [sic] thick and lac [sic] ‘feel’”, “hand gloves are too stiff” | |
Generally hard to use [6] | “The full length rubber glove that came with booth hard to use” | |
Tear easily [5] | “Some difficulty applying gloves onto the booth - the gloves tear easily” | |
Hard to insert/remove hands [4] | “the gloves are too rigid, VERY hard to even get my hands in, granted that I have big hands, size 8 | |
Slippery [3] | “The gloves are slippery and makes handling poor.” | |
Hard to change gloves [1] | “Gloves that can be easily fitted and changed” | |
Accommodating different-sized users [20] | Height & restrictiveness of glove port [16] | “Booth is not user friendly as there is a restriction in terms of height due to the fixed location of the hand glove position. it restricts the height of both the swabber and patients” |
Could not swab sitting/wheelchair patients [6] | “it is not wheelchair or elderly friendly.” | |
Cubicle too small or short [2] | “however, the top of the booth is too low for Caucasian patients” “For a ladies [sic] frame it’s a good fit but not for the larger built guys” | |
Dimensions [19] | Too bulky/wanted foldable [10] | “Try to design a foldable one.” “no need to be so bulky and tall” |
Patient cubicle dimensions [3] | “Too far for patient. Patient can move away during swab.” | |
Too heavy [3] | “heavy to push in and out of the clinic after every session” | |
Miscellaneous [19] | Want it more enclosed [6] | “There is no “door” to total close patient in so to ensure the aerosol particles are contain within the booth…” |
Enhance places to put things [5] | “Put a ledge on patients’ side so the things less likely to drop” “compartments to put disinfectants and swabbing materal [sic]” | |
Others [8] – 2 or fewer comments per theme | “Difficult for patient to hear me while swabbing - I bought a mic and speaker set to overcome this” |
“I am very grateful for the booth, without which I would not have started doing the swab. The peace of mind it gives me is tremendous, as I am already 67 and have co morbidity as well. Hence the swab booth gives me the opportunity to help in the fight against Covid. Thank you again.”