Mixed-methods process evaluation of a residence-based SARS-CoV-2 testing participation pilot on a UK university campus during the COVID-19 pandemic

Background: Regular testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is an important
strategy for controlling virus outbreaks on university campuses during the COVID-19 pandemic but testing participation rates can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel intervention implemented
at two student residences on a large UK university campus over 4 weeks. The aim of the pilot was to increase the
frequency of asymptomatic SARS-CoV-2 saliva testing onsite. This process evaluation aimed to determine whether RBTPP was implemented as planned and identify implementation barriers and facilitators.
Methods: A mixed-methods process evaluation was conducted alongside the RB-TPP. Evaluation participants were
students (opting in, or out of RB-TPP) and staf with a role in service provision or student support. Monitoring data
were collected from the intervention delivery team and meeting records. Data were collected from students via
online survey (n =152) and seven focus groups (n =30), and from staf via individual interviews (n =13). Quantitative
data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were
mapped to the ‘Capability, Opportunity, Motivation–Behaviour’ (COM-B) behaviour change framework.
Results: Four hundred sixty-four students opted to participate in RB-TPP (98% of students living onsite). RB-TPP
was implemented broadly as planned but relaxed social distancing was terminated early due to concerns relating
to national escalation of the COVID-19 Delta variant, albeit testing continued. Most students (97.9%) perceived the
period of relaxed social distancing within residences positively. The majority engaged in asymptomatic testing (88%);
46% (52% of testers) were fully compliant with pre-determined testing frequency. Implementation was facilitated by
convenience and efciency of testing, and reduction in the negative impacts of isolation through opportunities for
students to socialise. Main barriers to implementation were perceived mixed-messages about the rules, ambivalent
attitudes, and lack of adherence to COVID-19 protective measures in the minority.
Conclusions: This process evaluation identifes factors that help or hinder the success of university residence-based
outbreak prevention and management strategies. RB-TPP led to increased rates of SARS-CoV-2 testing participation
among students in university residences. Perceived normalisation of university life signifcantly enhanced student