Background
How may RDD (not) benefit CT? | PHPs anticipated that RDD may… • …accommodate easy and autonomous participation in CT by index cases and contact persons, • …increase the efficiency of CT, • …limit opportunities for PHPs to support, motivate, and coordinate the execution of CT, • …complicate conveying measures to index cases and contact persons, • …lead to unrest among index cases and contact persons. |
When may RDD be applied for CT and when not? | • RDD may be particularly applicable in situations that involve digitally skilled and literate persons, and many contact persons. • RDD may be less applicable in situations that involve the risk of (severe) consequences for individual or public health, when complex or impactful measures may need to be taken to prevent further spread of a pathogen, and when a disease is perceived as severe or sensitive by index cases and contact persons. |
Would PHPs like to use RDD for CT in practice? | • A majority of PHPs (71%) indicated that they would want to use RDD for CT in practice. • The circumstances under which CT is performed appear to strongly influence PHPs’ anticipated (dis)advantages of RDD and their intention to use RDD for CT in practice. |
Methods
Phase 1: qualitative data collection and analysis
Sampling
Data collection and development of research materials
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Scenario 1, ‘Scabies’: A student living in a student housing complex, who was diagnosed with scabies after having had experienced symptoms for approximately 3 months.
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Scenario 2, ‘Shigella’: A middle-aged individual who was diagnosed with shigella upon returning to his home country from an organised group holiday with friends.
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Scenario 3, ‘Mumps’: A student with a side-job as a baby-sitter, who was diagnosed with mumps.
Data analysis
Phase 2: quantitative data collection and analysis
Sampling
Online questionnaire
Statistical analyses
Results
Study participants
Interviewees (n = 12) | Respondents (n = 70) | |
---|---|---|
Age, in years (M;IQR) | 38.5 (34.5–56.8) | 49 (36–59.3) |
Sex (%) | ||
- Male | 4 (33.3) | 22 (31.4) |
- Female | 8 (66.7) | 48 (68.6) |
Province of employment (%) | ||
- Brabant | . | 6 (8.6) |
- Caribbean Netherlandsa | . | 1 (1.4) |
- Drenthe | . | 1 (1.4) |
- Flevoland | . | 1 (1.4) |
- Friesland | . | 2 (2.9) |
- Gelderland | . | 14 (20.0) |
- Groningen | . | 5 (7.1) |
- Limburg | 4 (33.3) | 7 (10.0) |
- North-Holland | . | 13 (18.6) |
- Overijssel | . | 6 (8.6) |
- Utrecht | 5 (41.7) | 4 (5.7) |
- Zeeland | . | 1 (1.4) |
- South-Holland | 3 (25) | 9 (12.9) |
Role (%) | ||
- PHS nurse | 6 (50.0) | 33 (47.1) |
- PHS doctor | 6 (50.0) | 35 (50.0) |
- PHS manager | . | 2 (2.9) |
Experience with contact tracing, in years (M;IQR) | 9 (4.8–14.8) | 11 (6–19.3) |
Advantages and challenges of RDD for CT
Advantages of RDD for CT
Themes | Illustrative quotes |
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Accommodating easy and autonomous participation in CT for index cases and contact persons. | “I think you can take away many barriers by having the index forward this [the online CT-questionnaire]. Especially if it is possible to do so anonymously. For example, with scabies, all the bed partners, and with mumps, all the kissing partners… We do not actually need to know all of that. They can just warn those themselves.” Nurse, mid-thirties |
“In today’s society, during the day people work, sleep, or are unavailable. This provides opportunities to go around that … so those who are hard to reach by telephone could think “this is easy, I’ll just do this tonight.” Nurse, mid-thirties | |
Reaching contact persons more efficiently in CT. | “I believe it’s just more efficient to handle things this way [with RDD]. And if things can be done more efficiently, that appeals to me. It saves you time.” Doctor, late-twenties |
“There is an advantage for the index. With the push of a button, he can just contact his whole group. And the information will come back quickly. So… I believe that is very efficient.” Doctor, mid-fifties |
Accommodating easy and autonomous participation in CT for index cases and contact persons
Reaching contact persons more efficiently in CT
Challenges for CT with RDD
Themes | Illustrative quotes |
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Limited opportunities for PHPs to support, motivate, and coordinate the execution of CT. | “I do not know if you can really create a sense of urgency when you just send someone a web-link. Sometimes a PHS has a bit more authority, so that people really take it seriously.” Doctor, mid-fifties |
“You let go of the part where you yourself call someone. The part of: ‘will this be sent to the right people?, are we missing anyone?, are we not informing too many people?’ You can try to incorporate that into the system, but that danger will always remain.” Nurse, early-forties | |
Not being able to adequately convey measures to index cases and contact persons. | “Does someone understand what he is reading and what the consequences are? It makes you dependent of what the other person does. I do see it as an opportunity, but also as a risk to in the end not be able to execute the measures you would like to.” Nurse, early-thirties |
Anticipated unrest among index cases and contact persons. | “The feeling I get of people … is that they appreciate to be talked to personally, so that we as professionals can explain why we call, and why we are asking questions. Then they can also ask their questions straight away. Then you can immediately take away a little bit of unrest. They immediately think the worst, that they are sick.” Nurse, early-forties |