Table 3 NPT constructs, themes, and illustrative data/analysis

Coherence | sense making

Variable buy-in | communal specification

“Staff and residents had a lack of understanding. My understanding wasn’t there, and I can’t expect someone to understand something that I don’t understand myself” (home 1, study champion)

Legitimacy and credibility | individual specification

“No investment from staff, it was not engrained within in the care home enough. As much as we could tell them to wear them, there are more than 100 people. I think it was up to the leads to encourage staff to wear the device, and that approach wasn’t there. The staff didn’t really remember or care to do it.” (home 4, study champion)

Across-role engagement | individual and communal specification

Managers and senior staff demonstrated understanding and engagement, others had minimal understanding and engagement

Carer engagement | individual specification

“I wear my device at all times, but I know others take theirs off …” (home 2, care assistant)

Cognitive participation | work to promote CONTACT engagement

Identifying and appointing the right key staff | initiation | enrolment

In three smaller homes, managers took on champion roles as there were no staff judged to have the requisite skills

Finding and engaging gatekeepers for whole home engagement initiation | enrolment | activation |

Against advice, one home appointed multiple study champions. In three smaller homes, managers assumed study champion roles and struggled to enact work required. Staff were gatekeepers (of variable quality) for recruiting and retaining resident participation

Enacting study tasks | legitimation |

Variable staff commitment meant key study tasks (CRFs, device logs, battery records) were variably completed

Diverse motivations | legitimation

Motives for participation were not always COVID-19 related

Acceptability and wearability | legitimation

Some staff removed devices when undertaking key personal care (assisting with feeding or personal hygiene). Some resident devices in suboptimal locations masking contacts (handbags, cupboards and drawers). Managerial estimates of compliance (~ 80% wear) did not match observed reality (7% in one 15-min observation period of 41 people in a communal area)

Collective action | individual’s CONTACT enactment work

Balancing workload against available resources interactional workability

“…difficult to prepare for such a big workload when one doesn’t know what’s coming. Don’t know until you do it. Wouldn’t have put us off, but we would have been better prepared” (home 4, manager)

Training and support from a distance | relational integration | skill set workability (training)

Remote and virtual training led to attendance of between 33 and 100% (mean 65%)

Credibility of CONTACT data | relational integration | relational integration (disruption)

“I wasn’t confident with some of the data on the scheduled report because the locations were showing people were having contacts and congregating in the corridors, and I know for sure that they don’t meet there. So that was lacking in the accuracy, a lot of the contacts in my home happen in rooms, like day rooms and dining rooms” (home 3, manager)

“The scheduled reports seem to replicate what was happening, it made sense as it showed staff were supposed to be where they should be. That give me the confidence it was picking up the people it should. It then translated into confidence that it would be a useful tool to monitor where the infections were and how they would be transferred” (home 1, manager)

Reflexive monitoring | appraising CONTACT

Negative feedback learning loops and balance | communal and individual appraisal

“The triggered report covered mostly what we knew already. I did analyse the scheduled report which identified which residents are most at risk. But if you find out which individuals are most at risk, what can you really do with that information? We can make people isolate but then you lose staff. The staff do a lateral flow test before work every morning, that’s the protection we already have, without losing too many staff” (home 4, study champion)