COVID-19 Contact Tracing Apps Research Articles

Developing and Evaluating Digital Public Health Interventions Using the Digital Public Health Framework DigiPHrame: A Framework Development Study.

Digital public health (DiPH) interventions may help us tackle substantial public health challenges and reach historically underserved populations, in addition to presenting valuable opportunities to improve and complement existing services. However, DiPH interventions are often triggered through technological advancements and opportunities rather than public health needs. To develop and evaluate interventions designed to serve public health needs, a comprehensive framework is needed that systematically covers all aspects with relevance for public health. This includes considering the complexity of the technology, the context in which the technology is supposed to operate, its implementation, and its effects on public health, including ethical, legal, and social aspects. We aimed to develop such a DiPH framework with a comprehensive list of core principles to be considered throughout the development and evaluation process of any DiPH intervention. The resulting digital public health framework (DigiPHrame) was based on a scoping review of existing digital health and public health frameworks. After extracting all assessment criteria from these frameworks, we clustered the criteria. During a series of multidisciplinary meetings with experts from the Leibniz ScienceCampus Digital Public Health, we restructured each domain to represent the complexity of DiPH. In this paper, we used a COVID-19 contact-tracing app as a use case to illustrate how DigiPHrame may be applied to assess DiPH interventions. The current version of DigiPHrame consists of 182 questions nested under 12 domains. Domain 1 describes the current status of health needs and existing interventions; domains 2 and 3, the DiPH technology under assessment and aspects related to human-computer interaction, respectively; domains 4 and 5, structural and process aspects, respectively; and domains 6-12, contextual conditions and the outcomes of the DiPH intervention from broad perspectives. In the CWA use case, a number of questions relevant during its development but also important for assessors once the CWA was available were highlighted. DigiPHrame is a comprehensive framework for the development and assessment of digital technologies designed for public health purposes. It is a living framework and will, therefore, be updated regularly and as new public health needs and technological advancements emerge.

The role of nudge-based messages on the acceptability and download of COVID-19 contact tracing apps: survey experiments

AbstractWe investigated the effectiveness of nudge-based messages in promoting the download of contact tracing apps, particularly in the context of low uptake due to serious distrust in the product. Even in the presence of distrust towards the app, promoting downloads can be a beneficial means of preventing infection spread at a stage before pharmacological interventions, such as vaccines or therapeutic drugs, are established. Two studies were conducted with Japanese residents who had not yet downloaded any contact tracing apps. Study 1, based on smartphone location data, targeted 2690 individuals who had gone out despite public instructions to stay at home. Study 2 targeted 4126 individuals whose web-search behavior could be tracked. Nudge-based messages did not increase app downloads in either study. In Study 1, where participants were considered non-cooperative, these messages also did not enhance acceptability such as willingness to accept and intention to download the apps. Conversely, in Study 2, a more representative sample, nudge-based messages emphasizing altruism, economic losses, and medical losses increased app acceptability, although they did not increase searches related to the app's keywords.

Perceptions of the Agency and Responsibility of the NHS COVID-19 App on Twitter: Critical Discourse Analysis.

Since September 2020, the National Health Service (NHS) COVID-19 contact-tracing app has been used to mitigate the spread of COVID-19 in the United Kingdom. Since its launch, this app has been a part of the discussion regarding the perceived social agency of decision-making algorithms. On the social media website Twitter, a plethora of views about the app have been found but only analyzed for sentiment and topic trajectories thus far, leaving the perceived social agency of the app underexplored. We aimed to examine the discussion of social agency in social media public discourse regarding algorithm-operated decisions, particularly when the artificial intelligence agency responsible for specific information systems is not openly disclosed in an example such as the COVID-19 contact-tracing app. To do this, we analyzed the presentation of the NHS COVID-19 App on Twitter, focusing on the portrayal of social agency and the impact of its deployment on society. We also aimed to discover what the presentation of social agents communicates about the perceived responsibility of the app. Using corpus linguistics and critical discourse analysis, underpinned by social actor representation, we used the link between grammatical and social agency and analyzed a corpus of 118,316 tweets from September 2020 to July 2021 to see whether the app was portrayed as a social actor. We found that active presentations of the app-seen mainly through personalization and agency metaphor-dominated the discourse. The app was presented as a social actor in 96% of the cases considered and grew in proportion to passive presentations over time. These active presentations showed the app to be a social actor in 5 main ways: informing, instructing, providing permission, disrupting, and functioning. We found a small number of occasions on which the app was presented passively through backgrounding and exclusion. Twitter users presented the NHS COVID-19 App as an active social actor with a clear sense of social agency. The study also revealed that Twitter users perceived the app as responsible for their welfare, particularly when it provided instructions or permission, and this perception remained consistent throughout the discourse, particularly during significant events. Overall, this study contributes to understanding how social agency is discussed in social media discourse related to algorithmic-operated decisions This research offers valuable insights into public perceptions of decision-making digital contact-tracing health care technologies and their perceptions on the web, which, even in a postpandemic world, may shed light on how the public might respond to forthcoming interventions.

Effectiveness of a COVID-19 contact tracing app in a simulation model with indirect and informal contact tracing

During the COVID-19 pandemic, contact tracing was used to identify individuals who had been in contact with a confirmed case so that these contacted individuals could be tested and quarantined to prevent further spread of the SARS-CoV-2 virus. Many countries developed mobile apps to find these contacted individuals faster. We evaluate the epidemiological effectiveness of the Dutch app CoronaMelder, where we measure effectiveness as the reduction of the reproduction number R. To this end, we use a simulation model of SARS-CoV-2 spread and contact tracing, informed by data collected during the study period (December 2020 - March 2021) in the Netherlands. We show that the tracing app caused a clear but small reduction of the reproduction number, and the magnitude of the effect was found to be robust in sensitivity analyses. The app could have been more effective if more people had used it, and if notification of contacts could have been done directly by the user and thus reducing the time intervals between symptom onset and reporting of contacts. The model has two innovative aspects: i) it accounts for the clustered nature of social networks and ii) cases can alert their contacts informally without involvement of health authorities or the tracing app.

Adoption of a COVID-19 Contact Tracing App by Czech Youth: Cross-Cultural Replication Study.

During the worldwide COVID-19 pandemic crisis, the role of digital contact tracing (DCT) intensified. However, the uptake of this technology expectedly differed among age cohorts and national cultures. Various conceptual tools were introduced to strengthen DCT research from a theoretical perspective. However, little has been done to compare theory-supported findings across different cultural contexts and age cohorts. Building on the original study conducted in Belgium in April 2020 and theoretically underpinned by the Health Belief Model (HBM), this study attempted to confirm the predictors of DCT adoption in a cultural environment different from the original setting, that is, the Czech Republic. In addition, by using brief qualitative evidence, it aimed to shed light on the possible limitations of the HBM in the examined context and to propose certain extensions of the HBM. A Czech version of the original instrument was administered to a convenience sample of young (aged 18-29 y) Czech adults in November 2020. After filtering, 519 valid responses were obtained and included in the quantitative data analysis, which used structural equation modeling and followed the proposed structure of the relationships among the HBM constructs. Furthermore, a qualitative thematic analysis of the free-text answers was conducted to provide additional insights about the model's validity in the given context. The proposed measurement model exhibited less optimal fit (root mean square error of approximation=0.065, 90% CI 0.060-0.070) than in the original study (root mean square error of approximation=0.036, 90% CI 0.033-0.039). Nevertheless, perceived benefits and perceived barriers were confirmed as the main, statistically significant predictors of DCT uptake, consistent with the original study (β=.60, P<.001 and β=-.39; P<.001, respectively). Differently from the original study, self-efficacy was not a significant predictor in the strict statistical sense (β=.12; P=.003). In addition, qualitative analysis demonstrated that in the given cohort, perceived barriers was the most frequent theme (166/354, 46.9% of total codes). Under this category, psychological fears and concerns was a subtheme, notably diverging from the original operationalization of the perceived barriers construct. In a similar sense, a role for social influence in DCT uptake processes was suggested by some respondents (12/354, 1.7% of total codes). In summary, the quantitative and qualitative results indicated that the proposed quantitative model seemed to be of limited value in the examined context. Future studies should focus on reconceptualizing the 2 underperforming constructs (ie, perceived severity and cues to action) by considering the qualitative findings. This study also provided actionable insights for policy makers and app developers to mitigate DCT adoption issues in the event of a future pandemic caused by unknown viral agents.

Examining Antecedents of Factual Knowledge and Perceived Familiarity of COVID-19 Contact Tracing App: A Modified Cognitive Mediation Model

This study employs a modified cognitive mediation model to investigate the role of health valuation and fear in shaping media attention, factual knowledge, and perceived familiarity with COVID-19 contact tracing apps. Data were collected from a national survey of 906 Singaporeans, and structural equation modeling was used to analyze the results. Findings indicated that both fear of COVID-19 and health valuation were positively associated with newspapers, television, and social media attention, with health valuation demonstrating a stronger association with each media type. This suggests that health valuation, as an intrinsic motivation, is more critical in information-seeking behavior related to emerging health technologies. However, media attention on all platforms did not correlate with factual knowledge of COVID-19 contact tracing apps, whereas attention to social media was positively associated with perceived familiarity with these apps. This result highlights the potential influence of social media in shaping public perceptions, warranting further investigation into the quality and accuracy of the information disseminated. News elaboration was found to have a positive association with both factual knowledge and perceived familiarity with COVID-19 contact tracing apps. This underscores the need for effective communication strategies to promote accurate understanding of health technologies and emphasizes the role of individual motivations in shaping media consumption and information processing.

Covid-19 contact-tracing apps and the public/private co-production of security

This article examines how the smartphone contributes to the co-production of security through an analysis of Covid-19 contact-tracing apps. Building on existing research in security studies that mobilizes the science and technology concept of co-production, the article proposes the notion of ‘appropriation’ as a concrete way of extending our understanding of the public/private co-production of security. Appropriation highlights how consumer technology may be repurposed for security and shows how private-sector actors that own consumer technology not only influence, but actively condition the co-production of security. Bringing new, typically commercial, concerns to bear on security practices, appropriation also has the effect of complicating conventional understandings of the relationship between liberty and security. Focusing on the NHS Covid-19 app and its contentious relationship with Google/Apple’s framework for digital contact-tracing, the article demonstrates how the smartphone enables private-sector actors to gain influence in the security domain. Google and Apple used their control over smartphone technology to compel the British health authorities to adopt a less effective but more privacy-preserving approach than they originally intended, and thus enforced a seemingly liberal response to an exceptional political situation.

“The pingdemic has been a greater challenge than Covid itself”: semantic prosodies in UK newspaper articles during the pandemic

In July 2021, the UK recorded an increase in self-isolation notifications to the users of the NHS Covid-19 contact-tracing app. The term pingdemic was coined and used widely in the media to refer to this period of increased notifications. Whilst existing research on language evolution during Covid-19 focuses on the negative connotations of the term pandemic, little attention has been dedicated yet to the connotations of the term pingdemic. Thus, this study contributes a com- parison between the semantic prosody of pingdemic and its benchmark pandemic, through the corpus analysis of 628 UK printed newspaper articles, published during the peak in notifications to add to the increasing knowledge of how the pandemic evolved in the UK and how AI has had an impact on it. With the aid of the Sketch Engine, through the analysis of keywords, collocations and Word Sketch Difference visualisations, we found that pingdemic held a more negative semantic prosody than pandemic.

The resistance toward COVID-19 contact tracing apps: A study of psychological reactance among young adults in Italy

Western governments’ attempts to encourage young adults to adopt COVID-19 contact tracing apps (CTAs) have been unsuccessful. Drawing on psychological reactance theory, we propose that government-imposed containment measures (e.g., lockdowns, curfews) may cause young adults to resist CTAs. We investigate how and when threats to freedom posed by government-imposed containment measures to young adults reduce their CTA adoption intentions. We conducted a survey of young adults during the second general lockdown (March‒April 2021) in Italy. The results show that when young Italian adults focus on the restrictive nature of government-imposed containment measures, their sense of freedom is threatened. Threats to freedom produce psychological states of either helplessness or reactance, depending on if young Italian adults think they can recover their freedom. Helpless young adults are motivated to adopt CTAs because they seek guidance from containment measures. Reactant young adults resist CTAs because they exhibit aversive psychological states toward containment measures. These results offer relevant insights for policymakers. They shed light on young Italian adults’ resistance toward CTAs. They also inform governments on how to interact more efficiently with young adults if a novel pandemic should occur.

Augmented body surveillance: Human microchip implantations and the omnipresent threat of function creep

Implanted microchips can store users' medical, financial, and other personal information, and provide users with easy and quick access to various locations and items. While adopted for their convenience outside of the healthcare sector, these invasive, semi-permanent implantable devices create augmented bodies that can be subject to ubiquitous surveillance. Situating human microchip implantations within surveillance literature, we draw from neoliberal perspectives of surveillance to examine augmented bodies, particularly as sources for market activity and as subjects of social control and sorting when these bodies are used as access control mechanisms, payment methods, and tracking means in employment, residential, commercial, and transportation sectors. History has demonstrated time and time again how unfettered technology applications and uses have led to real and/or perceived misuse by private and public sectors. Through the lens of function creep, we identify a pattern of expansion of applications and uses of technology beyond those originally intended across new technologies, such as DNA genetic genealogy databases, IoT wearables, and COVID-19 contact tracing apps, and provide illustrative examples of function creep, particularly the use of these technologies in criminal investigations and prosecutions despite not being intended or marketed for such use. By demonstrating the lack of clearly defined boundaries in the applications and uses of various new technologies and their associated data, and the ways they were misused, we demonstrate how human microchip implantations are headed on a similar path. The current and potential future uses of this technology raise concerns about the absence of regulation, law, and policy barring or limiting its application and use in specific sectors, and the impact of this technology on users’ security, data protection, and privacy. Undeniably, the present and potential future functions, applications, uses, and extensions of human microchip implantations in various sectors warrant a proactive examination of their security, privacy, and data protection consequences and the implementation of proactive policies to regulate new and currently unregulated uses of this technology and its associated data within these sectors.

The technology-behavioral compensation effect: Unintended consequences of health technology adoption

In their pursuit of public health goals, policymakers increasingly turn to innovative apps to complement existing health measures. However, findings from previous research in non-IT health contexts indicate that individuals may compensate for new interventions (e.g., start exercising) by reducing existing preventive health behaviors (e.g., eating fewer healthy foods). However, the findings are inconclusive, and it is unknown when people tend to engage in behavioral compensation. Building on this observation, we draw on rational choice theory to substantiate the subjective rationality of compensation behavior and develop a utility maximization model that suggests circumstances under which adoption of technological innovation may lead to users reducing existing preventive health behaviors. This research provides evidence from a multi-wave study on COVID-19 contact-tracing apps that confirms the existence of what we term the technology-behavioral compensation effect: Individuals who perceive the app to be highly useful or actively use it reduce other preventive health behaviors (e.g., social distancing) after app adoption. Ironically, this technology-behavioral compensation effect indicates a hitherto-overlooked tension between two established IS design goals (i.e., perceived usefulness and active use) and the successful exploitation of technology to support users’ health. We expand research on dark side effects of IS use by revealing a previously neglected type of unintended consequence and elaborate on its implications for research well beyond the health context. Our findings also will help policymakers make decisions on the design of societal technologies.

The role of ethics in technology acceptance: analysing resistance to new health technologies on the example of a COVID-19 contact-tracing app

ABSTRACT New health technologies promise enormous benefits for human wellbeing, yet their diffusion is often inhibited by potential users’ uncertainty about their consequences. Since ethics help individuals to cope with uncertainty, this study investigates the potential of ethics to promote technology acceptance. To this end, we test the influence of typical acceptance predictors (perceived health threat, privacy attitudes, and technology readiness) and two new ethics-related variables (‘ethical optimism’ and ‘perceived governmental responsibility’) on resistance to a government-issued COVID-19 contact-tracing app. Using structural equation modelling, we find significant effects of the typical acceptance predictors, and that ethical optimism and perceived governmental responsibility interact in determining the resistance to the tracing app. The paper highlights the relevance of ethics for the acceptance of new (health) technologies and suggests that the role of ethics is not confined to being a ‘moral watchdog’ but can serve as a powerful lever to promote their acceptance.

The use of COVID-19 contact tracing app data as evidence of a crime

This commentary draws attention to the introduction of data collected by COVID-19 tracing apps as evidence in criminal proceedings and the novel considerations this evidence presents for criminal justice agents and digital forensics professionals.

Smartphone-Based COVID-19 Contact Tracing Apps – Insights from New Zealand

Smartphone-Based COVID-19 Contact Tracing Apps – Insights from New Zealand

Attitudes Towards COVID-19 Contact Tracing Apps: A Cross-National Survey

To help prevent the spread of COVID-19, countries around the world have implemented a range of measures and virus containment strategies, including digital contact-tracing (DCT) in the form of smartphone apps. While early studies showed a high level of acceptability of such technologies, the adoption rates varied greatly between countries after contact-tracing apps became available to download. This cross-national user survey ( <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">${n}=871$ </tex-math></inline-formula> ) aims to explore public attitudes and factors that affect user acceptability and adoption of contact-tracing apps in the USA, UK, and the Republic of Ireland, which employ similar underlying technology, but have uneven adoption rates. The results indicate interactions between installation decisions and public trust in actors and institutions communicating COVID-related information, and releasing such technologies. Beyond the immediate case of contact tracing, our findings hold implications for the deployment and communicative framing of technology for public health and the public good, and inform the design of crisis response public health information systems.

Exploring young adults’ unwillingness to adopt COVID-19 contact tracing apps: A mixed-method study

Exploring young adults’ unwillingness to adopt COVID-19 contact tracing apps: A mixed-method study

Individuality and Fairness in Public Health Surveillance Technology: A Survey of User Perceptions in Contact Tracing Apps

Machine learning algorithms are playing an increasingly important role in public health measures, accelerated by the Covid-19 pandemic. It is therefore vital that machine learning algorithms are applied in ways that are generally considered fair. However, the question of how to define fairness in a public health context is still an open one. In this study, we investigated people’s attitudes towards two ways of defining fairness in the context of Covid-19 contact tracing apps. In the first, ‘high-individuality’ approach, the likelihood of an algorithm asking a person to self-isolate would depend on the person’s individual characteristics, such as their risk of spreading the virus through regular contacts. In the second ‘low individuality’ approach, these individual characteristics would not be used to come to a decision. For each approach, participants rated its fairness, overall quality, and their privacy concerns, and answered questions about basic psychological need satisfaction. Participants rated the high-individuality approach as fairer and better overall compared to the low-individuality approach, despite having greater privacy concerns. Further, we found a strong correlation between the participants’ fairness perceptions and their overall impression of the tracking tool. Together, these findings suggest that people prefer individualised approaches in some contexts and perceive them as fairer. However, policy makers should consider the privacy trade-off of employing such measures.

Effectiveness, Policy, and User Acceptance of COVID-19 Contact-Tracing Apps in the Post-COVID-19 Pandemic Era: Experience and Comparative Study.

BackgroundIn the post–COVID-19 pandemic era, many countries have launched apps to trace contacts of COVID-19 infections. Each contact-tracing app (CTA) faces a variety of issues owing to different national policies or technologies for tracing contacts.ObjectiveIn this study, we aimed to investigate all the CTAs used to trace contacts in various countries worldwide, including the technology used by each CTA, the availability of knowledge about the CTA from official websites, the interoperability of CTAs in various countries, and the infection detection rates and policies of the specific country that launched the CTA, and to summarize the current problems of the apps based on the information collected.MethodsWe investigated CTAs launched in all countries through Google, Google Scholar, and PubMed. We experimented with all apps that could be installed and compiled information about apps that could not be installed or used by consulting official websites and previous literature. We compared the information collected by us on CTAs with relevant previous literature to understand and analyze the data.ResultsAfter screening 166 COVID-19 apps developed in 197 countries worldwide, we selected 98 (59%) apps from 95 (48.2%) countries, of which 63 (66.3%) apps were usable. The methods of contact tracing are divided into 3 main categories: Bluetooth, geolocation, and QR codes. At the technical level, CTAs face 3 major problems. First, the distance and time for Bluetooth- and geolocation-based CTAs to record contact are generally set to 2 meters and 15 minutes; however, this distance should be lengthened, and the time should be shortened for more infectious variants. Second, Bluetooth- or geolocation-based CTAs also face the problem of lack of accuracy. For example, individuals in 2 adjacent vehicles during traffic jams may be at a distance of ≤2 meters to make the CTA trace contact, but the 2 users may actually be separated by car doors, which could prevent transmission and infection. In addition, we investigated infection detection rates in 33 countries, 16 (48.5%) of which had significantly low infection detection rates, wherein CTAs could have lacked effectiveness in reducing virus propagation. Regarding policy, CTAs in most countries can only be used in their own countries and lack interoperability among other countries. In addition, 7 countries have already discontinued CTAs, but we believe that it was too early to discontinue them. Regarding user acceptance, 28.6% (28/98) of CTAs had no official source of information that could reduce user acceptance.ConclusionsWe surveyed all CTAs worldwide, identified their technological policy and acceptance issues, and provided solutions for each of the issues we identified. This study aimed to provide useful guidance and suggestions for updating the existing CTAs and the subsequent development of new CTAs.

Students, Participatory Design, and Serious Games in a Response to: ‘No Algorithmization without Representation: Pilot Study on Regulatory Experiments in an Exploratory Sandbox’

No Algorithmization without Representation tracked a cohort of ‘Lithopy’ crypto-government sandbox participants in a longitudinal study looking at COVID-19 contact tracing app acceptance. These survey responses extended experiences with theoretical blockchain town governance by also tracking reasons for and against compliance with contact tracing apps. They found that the expressed opinions of students were incoherent and demanded technical or policy responses outside of the students’ direct experiences. In this response to that paper, I leverage the paper’s (commendable) open data to suggest that the sandbox’s claims of ‘No Algorithmization without Representation’ is a rediscovery of participatory design within the context of the serious games movement. While Role-Playing Games and War Games are excellent pedagogic tools xor planning tools—using undergraduate students’ participation in them as the basis of a claim for increased representation in technology policy is a bold claim. This claim is not fully substantiated by the paper’s data. Nevertheless, there is a need for better decision-making and public representation within technology design and policy-making spaces—making the claim for serious games as a meaningful public policy contribution not without merit.

3.F. Round table: Better DiPH – To plan, implement, evaluate, and the future of digital public health interventions

Abstract The potential of digital technology for improving the health of individuals, communities, and populations is unprecedented. Technological advancements empower individuals to engage in self-monitoring and self-management of their chronic conditions or health and well-being. There is an unparalleled opportunity to reform prevention, health promotion, and healthcare services with lower cost and better reach and accessibility. However, health technologies are often developed without supportive evidence or a user-centred design. This leads to a lack of long-term user engagement in digital public health interventions. Our workshop aims to facilitate a mutual understanding of the specific properties of digital public health tools by creating a space for discussing the various perspectives of such technologies. We want to start a conversation of essential steps for conceptualising, implementing, and evaluating needs-based and society-centred digital public health interventions to improve the acceptability and sustainability of such interventions in users. The workshop will address digital public health tools on different steps and describe the progression as an iterative approach to highlight where these aspects are linked. The first speaker will provide a theory-guided overview of digitalisation in health to create a shared understanding of the terminology for the workshop. This includes the differentiation between digital health and digital public health. The talk will highlight the importance of digital tools for surveillance, monitoring, healthcare, health promotion, and their significant meaning for society. Following this input, the other panellists will guide us through different aspects of digital public health tools: The second speaker will discuss the importance of society-centred designs based on users’ needs rather than on technological advancements for interventions. Our third speaker will present a meta-framework of extended criteria for developing and evaluating digital technologies for public health. The fourth panellist will share Malta's COVID-19 contact tracing app as a case study. He will discuss the challenges and facilitators in implementing and evaluating digital public health interventions. The last presentation will cover the need for governmental support in the future to ensure the success of digital public health interventions and holistic systems. The workshop will take place as a round table discussion. Each panellist will give a short (7 minute) input talk on the specific properties of digital public health tools. After the panellists present their opinion, we will open the floor for a discussion. Here, the audience is invited to share their knowledge and experiences to build a mutual understanding of the crucial steps in digital public health interventions. After the workshop, we will create a white paper on digital public health based on the panellists’ input and the discussion results. Key messages • A mutual understanding of digital public health may facilitate public sector cooperation and aim towards needs-based and society-centred technology development to improve the population's health. • Digital public health offers unique challenges, and there is an opportunity to outline these specific nuances to ensure maximum success in implementing such projects.