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

BackgroundEmerging 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. This innovative, clinically integrated program aimed to link Kaiser Permanente members diagnosed at their facilities directly with contact tracing and supportive clinical care via their network. This approach promised to address key logistical and behavioral challenges hampering traditional public health agencies. This paper evaluates the programs implementation in two California counties. MethodsWe conducted a retrospective, mixed-methods process evaluation of program activities from August 2020 to June 2021, including contact tracing implementation in Fresno and San Bernardino Counties. Our methods included scoping discussions with program stakeholders, development of an epidemiological timeline and program impact model, and document review. We also conducted semi-structured interviews with program stakeholders and staff. Interviews were conducted and audio-recorded via Zoom, transcribed, and analyzed in NVivo using inductive and deductive coding with a Framework Approach. ResultsWe reviewed 474 program documents and interviewed 47 participants. Study findings highlighted difficulties in adapting program scope due to competing partner visions of program mission and collaboration. Unforeseen data demands and complex external data sharing with public health systems further complicated and delayed program implementation. ConclusionEvaluation of this contact tracing program offers key insights into public health interventions during emergencies. While the California Contact Tracing Support Initiatives integrated design showed promise, challenges arose from data systems, inter-organizational dynamics, and planning. Findings emphasize the need for clear operational steps, real-time data monitoring, defined roles, and formalized public-private partnerships in preparedness planning. These are key lessons for future complex public health interventions, especially regarding adapting programs versus maintaining fidelity amidst evolving contexts.