Table 1

Implementation experiences across domains

DomainsThemesKey quotes
Intervention: home-based RDTs to screen primary school pupilsFraming of the intervention by school stakeholders as an option to minimise risks for staff and families, and to avoid school closures‘It was this balancing act between pedagogy, psychological needs of the children, and health protection. The risk assessment, what happens when we carry it into the school and get a wave of infections here.’ (school stakeholder 1)
Usability and reliability of the RDTs and associated concerns pre-implementation‘A key experience why I wasn’t against it was the practicability of this test. If this test would have meant offering children this other test [using nasopharyngeal swabs] on a regular basis, then I would have blocked it.’ (school stakeholder 1)
Concerns regarding additional burden for children, but less burdensome as compared with other measures (eg, mask mandates) or potential consequences‘That’s the concern that this brings in unnecessary unrest, in addition to the unrest that is already there in any case. Now there are even tests being done that potentially are positive.’ (school stakeholder 2)
Feasibility of home-based testing as compared with on-site screening, but risk of alternative use‘Otherwise you probably would have to do that somewhere in the school, that I think is difficult to implement. How do you do that with so many children, […] I don’t know how to imagine that.’ (mother 2)
Hopes for positive consequences of screening implementation‘That also was a question of the parents: If we participate in this study, do we still have to wear these stupid masks?’ (school stakeholder 1)
Framing as a research study important but also resulting in concerns regarding ulterior motives‘It’s not about testing the tests. It’s about figuring out: can we manage to create a good scenario to test ourself in our everyday lives? And does it really help to control the spread?’ (school stakeholder 1)
Individuals: pupils, parents and school staff using the testsMotivations for participation included an increased sense of safety and wanting to contribute to COVID-19 research‘We basically immediately decided to participate. Because if we don’t do research on this virus, you can’t analyze it. The more information you get about it, the better, and for us it wasn’t a big sacrifice to participate. […] And a higher sense of security of course is nice, too.’ (mother 4)
Appreciation for tests and intervention: overall good testing experiences across respondent groups‘In general, I found it great that this was done. I talked with colleagues who also have children in primary schools that don’t have tests. They were immediately jealous.’ (mother 5)
Gradual integration of testing into daily routines: from ‘annoyed’ and ‘scared’ to ‘like brushing teeth’‘In the beginning I always was a bit scared, but my mother said that it’s not that bad. Then I was really happy when the test was negative. [Now] I’m not afraid anymore. When I knew what was coming it wasn’t bad at all anymore.’ (female pupil 10)
No increased risk taking as a result, feeling of safety as the main consequence‘I still don’t party or meet a lot of people […] But in fact, this morning I tested myself. That is a good feeling, I’m happy then. You don’t expect anything but a negative result, but you’re just happy: This safety I have for today.’ (school stakeholder 3)
Surprise and incomprehension regarding concerns and criticism of those not participating‘I didn’t at all expect that anyone could have a problem with this testing and the study. I had thought: Everyone must see how reasonable this idea is, how little invasive that is for the outcome that means we have security for our children and for the village here.’ (mother 1)
Support system: trainers, study staff and external resourcesTelephone hotline and other contacts offered by the study team were appreciated (but not used by participants)‘In case of questions one also could have taken the initiative and reach you via e-mail or telephone, to follow up.’ (mother 10)
Train-the-trainer system for building self-testing capacity as feasible but lacking supervision‘Something I would have wished for to be different was how information was passed on. In our class it wasn’t really clear how you can get trained. The trainers in the end just said that whoever had questions could reach out.’ (mother 5)
External support (eg, local doctors) not used in light of lack of cases‘There were many options to reach out to in case of difficulties. Great.’ (mother 2)
Inner setting: periurban primary school in the context of the COVID-19 pandemicRDT-based screening as the newest development after more than 1 year of pandemic state of emergency‘It was an exceptionally difficult year. We had imagined it to be completely different, for the small children who still have to get used to the school routines, have to learn the rules, the continuity you usually have in the school.’ (father 8)
Screening not a dominant topic in intraschool interactions‘Almost noone cares about that. Also not everyone participates. Sometimes someone says something like: Do you also participate in the study? Or whether the test is pleasant or not. But the study does not play a big role in the school.’ (male pupil 1)
General perception of high screening acceptance within the school but debates outlining overarching disagreements regarding the pandemic‘We simply always have this dilemma: It’s about the children! […] We also have colleagues who see more the psychological needs of the children […] We also have colleagues who are more focused on the protection of health. […] This general thing that develops in the entire society does not completely pass over our staff.’ (school stakeholder 1)
Outer setting: legal, ethical and public discoursesOverarching dissatisfaction with policy decisions; screening in light of a year of constant and often rapid changes‘For a very long time I saw our workplace protection disregarded by the state government. Secondary schools received masks. Yes of course, there they introduced the mask mandate earlier […] and in our case they just assumed that small children are not infectious.’ (school stakeholder 1)
Shift to compulsory screening appreciated by most but concerns surfaced regarding potential shortcomings‘I don’t think that [that compulsory screening in the current form has a lot of benefits] because those who voluntarily participated in the study are the ones who want to actively help and see the danger. And those who didn’t participate probably have a different attitude.’ (father 8)
Implementation process: introducing RDTsImplementation ownership: initiated by and relying on local stakeholders‘[The school headmaster] also really stood up for this. That was also some educational work that was being done.’ (school stakeholder 4)
Implementation process as acceptable and successful; short time for decision-making and training as the new normal‘You can’t improve it because it already was good. I liked it that there were additional tests for trying it out [or] when one goes wrong. It was well communicated from the beginning. You were well informed via the information sheet. The pick-up of the tests was organized well, too. I liked the tests and the study, I don’t have particular recommendations.’ (mother 9)
Better communication might reduce barriers for participation‘Something I actually would have found helpful, from my perspective, would have been an online office hours to inform people about the tests [at the outset of the program when parents were deciding whether to engage] where you say: you have questions, and I am here to answer them.’ (school stakeholder 4)
  • RDT, rapid diagnostic test.