A Web-Based Intervention (Germ Defence) to Increase Handwashing During a Pandemic: Process Evaluations of a Randomized Controlled Trial and Public Dissemination

BackgroundWashing 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...

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Main Authors: Sascha Miller (Author), Ben Ainsworth (Author), Mark Weal (Author), Peter Smith (Author), Paul Little (Author), Lucy Yardley (Author), Leanne Morrison (Author)
Format: Book
Published: JMIR Publications, 2021-10-01T00:00:00Z.
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042 |a dc 
100 1 0 |a Sascha Miller  |e author 
700 1 0 |a Ben Ainsworth  |e author 
700 1 0 |a Mark Weal  |e author 
700 1 0 |a Peter Smith  |e author 
700 1 0 |a Paul Little  |e author 
700 1 0 |a Lucy Yardley  |e author 
700 1 0 |a Leanne Morrison  |e author 
245 0 0 |a A Web-Based Intervention (Germ Defence) to Increase Handwashing During a Pandemic: Process Evaluations of a Randomized Controlled Trial and Public Dissemination 
260 |b JMIR Publications,   |c 2021-10-01T00:00:00Z. 
500 |a 1438-8871 
500 |a 10.2196/26104 
520 |a BackgroundWashing 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. ObjectiveThis 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. MethodsThe 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. ResultsDuring 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). ConclusionsBy 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 RegistrationISRCTN Registry ISRCTN75058295; https://www.isrctn.com/ISRCTN75058295 
546 |a EN 
690 |a Computer applications to medicine. Medical informatics 
690 |a R858-859.7 
690 |a Public aspects of medicine 
690 |a RA1-1270 
655 7 |a article  |2 local 
786 0 |n Journal of Medical Internet Research, Vol 23, Iss 10, p e26104 (2021) 
787 0 |n https://www.jmir.org/2021/10/e26104 
787 0 |n https://doaj.org/toc/1438-8871 
856 4 1 |u https://doaj.org/article/1dd12f7ba5374e38b07bc8454f9da5dd  |z Connect to this object online.