JMIR Publications

ABSTRACT

Background:

Health systems had to rapidly implement infection control strategies to sustain their workforce during the COVID-19 pandemic. Various outbreak response tools, such as digital contact tracing (DCT), have been developed to monitor healthcare workers’ (HCW) exposures and symptoms. Limited research evidence exists on the experiences with these technologies and the impacts of DCT innovations from the perspective of stakeholders in healthcare environments.

Objective:

We describe the implementation, adoption, and impacts of a web-based DCT tool used at a specialized pediatric acute-care hospital in Ontario during the COVID-19 pandemic and assess the perspective of key stakeholders on its impacts and their experiences with its implementation.

Methods:

This qualitative study, conducted between December 2022 and April 2023, at the Children’s Hospital of Eastern Ontario, utilized the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to assess impact of DCT. We conducted 21 semi-structured interviews with key stakeholders including healthcare administrators (n=6; 29%), occupational health and safety specialists (n=8; 38%), and HCWs (n=7; 33%). Stakeholders were asked about the factors influencing engagement with the DCT tool, and organizational-level uptake, the implementation process, the long-term use and assimilation of DCT, and the unintended consequences. Verbatim transcripts were subject to thematic analysis using NVivo software.

Results:

The implementation of DCT was viable and well-received. End-users indicated that their engagement with the DCT tool was facilitated by its perceived ease of use and the ability to gain awareness of probable COVID-19 exposures; however, risk-assessment consequences and access concerns were reported as barriers (reach). Participants commonly agreed that the DCT technology had a positive influence on the hospital's capacity to meet the demands of COVID-19, notably through the facilitation of timely case investigations and by informing decision-making processes (effectiveness). Implementors and occupational specialists referred to negative staffing impacts, and the loss of nuanced information as unintended consequences (effectiveness). Safety-focused communication strategies and having a DCT tool that was human-centered were crucial factors driving staff adoption of the technology. Conversely, adoption was challenged by the misaligned delivery of the DCT tool with HCWs’ standard practices, alongside the evolving perceived threat of COVID-19. Stakeholders collectively agreed on the viability of DCT and its applicability to infectious disease practices (maintenance).

Conclusions:

This study provides an in-depth understanding of the processes by which DCT can be utilized. Hospital stakeholders were highly satisfied with DCT that was perceived as feasible and efficient, and having positive impacts on organizational safety. Our findings contribute to evidence-based practices and present benchmarks that can inform preparedness for future pandemics and infectious disease outbreaks.