Lessons in Implementing Complex Interventions in a Public Health Emergency: A Process Evaluation of the California Contact Tracing Support Initiative

Abstract

Abstract Background Emerging in January 2020, the SARS-CoV-2 pandemic quickly exposed the limitations of traditional contact tracing and overwhelmed the contact tracing efforts of US health departments. In response, Kaiser Permanente partnered with the Public Health Institute to launch the California Contact Tracing Support Initiative. To overcome logistical and behavioural challenges faced by public health agencies conducting contact tracing, this innovative, clinically integrated programme aimed to link Kaiser Permanente members diagnosed at their facilities directly with contact tracing and supportive clinical care via their network. This paper evaluates the programme’s implementation in two California counties. Methods We conducted a retrospective, mixed-methods process evaluation of programme activities from August 2020 to June 2021, including contact tracing implementation in Fresno and San Bernardino Counties. Our methods included scoping discussions with programme stakeholders, development of an epidemiologic timeline and programme impact model, and document review. We also conducted semi-structured interviews with programme stakeholders and staff. Interviews were conducted and audio-recorded via Zoom, transcribed, and analysed in NVivo using inductive and deductive coding with a Framework Approach. Results We reviewed 474 programme documents and interviewed 47 participants. Study findings highlighted difficulties in adapting programme scope due to competing partner visions of programme mission and collaboration. Unforeseen data demands and complex external data sharing with public health systems further complicated and delayed programme implementation. Conclusion Evaluation of this contact tracing programme offers key insights into public health interventions during emergencies. While the California Contact Tracing Support Initiative’s integrated design showed promise, challenges arose from data systems, inter-organisational dynamics, and planning. To address the specific data interoperability failures and inter-organisational misalignments observed, future preparedness planning should prioritise clear operational steps, real-time data monitoring, defined roles, and formalised public-private partnerships. These are key lessons for future complex public health interventions, especially regarding adapting programmes versus maintaining fidelity amidst evolving contexts.