A qualitative process evaluation using the behaviour change wheel approach: Did a whole genome sequence report form (SRF) used to reduce nosocomial SARS-CoV-2 within UK hospitals operate as anticipated?
Authors: Flowers Paul , Leiser Ruth , Mapp Fiona , McLeod Julie , Stirrup Oliver , Illingworth Christopher JR , Blackstone James , Breuer Judith 
Published: September 2022

PurposeTo conduct a process evaluation of a whole genome sequence report form (SRF) used to reduce nosocomial SARS-CoV-2 through changing infection prevention and control (IPC) behaviours. Here using qualitative behavioural analyses we report how the SRF worked.MethodsPrior to a multisite non-randomised trial of its effectiveness, the SRF was coded in relation to its putative behaviour change content (using the theoretical domains framework (TDF), the behaviour change wheel (BCW) and the behaviour change technique taxonomy (BCTTv1)). After the SRF had been used, through the peak of the Alpha variant, we conducted in-depth interviews from diverse professional staff (N=39) from a heterogeneous purposive sub-sample of hospital trial sites (n=5/14). Deductive thematic analysis explored participants’ accounts of using the SRF according to its putative content in addition to inductive exploration of their experiences.ResultsWe found empirical support for the putative theoretical mechanisms of ‘Knowledge’ and ‘Behavioural regulation’, as well as for intervention functions of ‘Education’ and ‘Persuasion’ and ‘Enablement’, and for particular BCTs ‘1.2 Problem solving’, ‘2.6 Biofeedback’, ‘2.7 Feedback on outcomes of behaviour’, and ‘7.1 Prompts and cues’. Most participants found the SRF useful and believed it could shape IPC behaviour.ConclusionsOur process evaluation of the SRF provided granular and general support for the SRF working to change IPC behaviours. Our analysis highlighted useful SRF content. However, we also note that, without complementary work on systematically embedding the SRF within routine practice and wider hospital systems, it may not reach its full potential to reduce nosocomial infection.What is already known on this subject?Health psychology remains under-exploited within infection prevention and control (IPC) interventionsFor genomic insights to be understood by a range of health care professionals and elicit changes in IPC behaviour, ways of translating complex genomic insights into a simple format are needed. These simple translation tools can be described as whole genome sequence report forms (SRFs)Nothing is currently known about the use of SRFs, for SARS-CoV-2 or other infections, to change hospital-based IPC behaviour.Health psychological tools such as the behaviour change wheel (BCW), the theoretical domains framework (TDF), and the behaviour change technique taxonomy (BCTTv1) are widely used to develop behaviour change interventions but are rarely used to evaluate themContemporary guidance on conducting process evaluations highlights the value of explicitly theorising how an intervention is intended to work before systematically examining how it actually worked in practiceWhat does this study add?The paper presents a novel worked example of using tools from health psychology within a qualitative process evaluation of using an SRF during the COVID-19 pandemic in UK hospitalsThis paper is the first to report how people experienced using whole genome sequence report forms (SRFs) in order to change hospital-based IPC behaviourWe provide qualitative evidence detailing empirical support for much of the SRF’s putative content, including casual mechanisms ‘Knowledge’ and ‘Behavioural regulation’, intervention functions such as ‘Education’ and ‘Enablement’, and for particular BCTs: ‘1.2 Problem solving’, ‘2.6 Biofeedback’, ‘2.7 Feedback on outcomes of behaviour’, and ‘7.1 Prompts and cues’