Usability, acceptability, and feasibility of a High-Density Microarray Patch (HD-MAP) applicator as a delivery method for vaccination in clinical settings

Figures & data

Figure 1. Study flow.

Figure 2. Intervention process.

Table 1. Participant demographics

		Professional Immunizers (n = 23)	Healthcare Workers (n = 38)
Trait	Value	% (n)	% (n)
Gender	Female	100 (23)	79 (30)
	Male	-	21 (8)
Age (years)	18–25	-	3 (1)
	26–35	-	40 (15)
	36–45	13 (3)	32 (12)
	46–55	44 (10)	16 (6)
	56–65	44 (10)	11 (4)
Country of birth	Australia	74 (17)	66 (25)
	Outside Australia	26 (6)	34 (13)
English main language	Yes	100 (23)	92 (35)
	No	-	8 (3)
Aboriginal or Torres Strait Islander descent	Yes	-	-
	No	100 (23)	100 (38)
Education	High school	-	3 (1)
	Apprenticeship	17 (4)	11 (4)
	Undergraduate degree	17 (4)	34 (13)
	Postgraduate degree	65 (15)	57 (20)
Occupation	Hospital Administration	-	11 (4)
	Doctor	-	26 (10)
	Registered nurse	100 (23)	24 (9)
	Allied Health	-	11 (4)
	Orderly/janitor	-	3 (1)
	Volunteer	-	8 (3)
	Other	-	18 (7)
Last injection of any type	Within 6 months	17 (4)	61 (23)
	6 months to 1 year ago	78 (18)	32 (12)
	1 to 5 years ago	4 (1)	5 (2)
	More than 5 years ago	-	-
	Don’t recall	-	3 (1)

Table 2. Percentage of HD-MAP administrations achieving all 5 essential criteria and mean HD-MAP wear time

	Professional Immunizers			Healthcare Workers
	% Achieving essential criteria	Mean wear time (SD)	Total number of administrations	% Achieving essential criteria	Mean wear time (SD)	Total number of administrations
HD-MAP Administration to self	100%	8.4s (1.9s)	42*	83%	10.2s (3.5s)	76^†
HD-MAP Administration to another adult participant	95%	9.2s (2.5s)	112^‡	N/A

* These 42 administrations were conducted by all 18 Group 1 Professional Immunizers who administered to 2 sites + 3 Group 4 Professional Immunizers who administered to 2 sites

^†These 76 administrations were conducted by all 38 Group 2 Healthcare Workers who administered to 2 sites

^‡These 112 administrations were conducted by all 18 Group 1 Professional Immunizers who administered to 2 sites + 1 Group 4 Professional Immunizer who administered to 2 sites to 38 Group 2 Healthcare Workers

Figure 3. HD-MAP applicator administration usability survey items.

Figure 4. HD-MAP applicator administration acceptability survey items.

Table 3. Illustrative quotes from Professional Immunizers (Groups 1 and 4) and Healthcare Workers (Group 2)

Theme	Sub-theme	Quote
Usability of HD-MAP applicator administration	Instructions for Use	Probably people with learning difficulties and things like that, might need supervision with it. Or might need someone else to actually do it for them (Group 4 PI #3) It [IFU] tells you exactly where to put it. It tells you what to peel off, how to peel the top off, that it clicks. Just to hold it there for 10 seconds and then remove it and put it in the bin. Like there’s nothing else. That’s the process. (Group 2 HCW #6, randomization = PI first)
	Ease of device use	It’s a one hand sort of application. Whereas the needles, I really feel you need to have that second hand on the child. (Group 4 PI #2)
	Convenience & time saving	[HD-MAP is] much faster, less scary for the patients to watch. (Group 4 PI #2) It was fairly quick. I see the HD-MAP that’s where you save time is there’s no mixing but a lot of needles, we just have to attach the needle without having to mix. Mixing takes a couple more seconds to do. (Group 4 PI #1)
Acceptability of HD-MAP applicator administration	Layperson Administration	I think they’d need instruction. So, perhaps if they needed further doses, you could do the first one and they could do the second one. I just don’t think you could send them instructions and they would get it right the first time. (Group 4 PI #2) As long as I’d be trained to do it properly and the instructions are clear I’d be confident to do it myself. (Group 2 HCW #24, randomization = PI first) Yeah. I could do that [self-administer HD-MAP] but I am also a registered nurse, so I think that I would be using my own clinical skill. (Group 2 HCW #12, randomization = HCW first)
	Managing adverse events	So, you’re still potentially having anaphylaxis and side effects from the vaccines, so you still must have appropriately trained personnel present. (Group 4 PI participant) I would be worried about self-administration because if people are doing that at home without any adrenalin then if they had a reaction then there’s the time delay. (Group 4 PI participant)
	Clinical Setting	Could you imagine flu vaccine done in hospitals? You could have a group of healthcare workers all sitting together and you’re all getting it at the same time and then that’s it. Then they’ve got to wait together. (Group 4 PI participant) From an adult’s perspective on the safety of the vaccine, I think it should also be supervised. Not because the person is an adult and can do it all by themselves. I think it would be safe and effective if it is supervised by someone else in the health sector. (Group 2 HCW #11, randomization = PI first)
	Preference for healthcare worker administration	I think it’s easier when the healthcare worker did it. They seemed to know what they were doing, and they’d obviously done it more times than I had, so they seemed to be more competent with it and more confident in the way that they administered it. (Group 2 HCW #24, randomization = PI first) Well, if I had a choice, I would go to the health professional knowing that they had been trained and I would put my trust in that person. (Group 2 HCW #18, randomization = HCW first)
	Emergency and remote setting	I think that would be a great idea for rural and remote communities, where there isn’t the same amount of people, with those same skills around, and everyone has to multi-skill anyway. It just makes that one skill a bit easier to achieve, and in part that benefits to the rest of the community. (Group 4 PI #3) The device that I saw carries a great potential. The potential that you could in theory, post it to someone who’s in a remote area. To then have them have to deal with sharps causes a great deal more logistic headache [than HD-MAP]. (Group 2 HCW #27, randomization = HCW first) One benefit would be that in a remote location they can be dropped by aeroplane. So, they can be given to more people in remote or difficult places. Or could be done quickly, like, in a pandemic or an epidemic, where really, everyone should be vaccinated very quickly. It would have a benefit because boxes of them could be sent to a whole lot of different locations and everyone could be vaccinated more quickly. (Group 2 HCW #26, randomization = PI first)

Table

□ 18–25

□ 26–35

□ 36–45

□ 46–55

□ 56–65

□ Over 65

Table

“I do not mind having an injection with a needle and syringe?”

Instruction: mark X anywhere along the line that describes your degree of agreement

Agreement

____________________________________________________________ 0% 25% 50% 75% 100%

Table

□ 18–25

□ 26–35

□ 36–45

□ 46–55

□ 56–65

□ Over 65

Table

“I do not mind having an injection with a needle and syringe?”

Instruction: mark X anywhere along the line that describes your degree of agreement

Agreement

___________________________________________________________ 0% 25% 50% 75% 100%