COVID-19 Contact Tracing Apps Research Articles

COVID-19 contact tracing apps in Europe, technological feat or failure?

Abstract Background In the context of infectious disease control (IDC), public health services (PHS) have been under great pressure during the COVID-19 pandemic, especially with the burden of contact tracing. Most European Union countries have developed contact tracing apps for smartphones (CTA) with the goal of aiding PHS in IDC. CTAs generally use proximity data from mobile devices to determine a user's risk of exposure to SARS-CoV-2, thus providing testing and isolation recommendations. This review aimed to study the acceptance and adoption of CTAs in Europe. Methods 5 European countries were selected: Germany, Spain, France, Ireland, Italy. A literature review was carried out and official sources of information from each country were consulted in order to compare the adoption of each national CTA. Criterias included number of downloads, rating in the app stores, costo of development, proportion of positive tests registered. Potential factors influencing population adherence to CTAs were also investigated. Results In proportion to their population, the number of downloads varied significantly in each country (18 % in Spain, 67% in France, 75% in Ireland). Except for Spain, all countries integrated additional functions into the CTA to increase its uptake, such as access to the vaccination certificate. App stores ratings ranged from 3.0 (Spain) to 3.9 (France and Ireland). The proportion of tests added in the apps varied significantly (1% in Italy and Spain, 4% in Ireland, 10% in France and 17% in Germany). Concerns that lead to the non-use of CTAs were related to data protection, smartphone battery drainage and app bugs. Conclusions CTAs as a way to identify contacts from a positive case had a low impact in the analyzed countries, with low population adherence being an important factor. Adding more features within the apps, minimizing bugs, and increasing public confidence in data privacy seem essential to increase uptake in the future. Key messages

Understanding Trust and Changes in Use After a Year With the NHS COVID-19 Contact Tracing App in the United Kingdom: Longitudinal Mixed Methods Study.

BackgroundDigital contact tracing (DCT) apps have been implemented as a response to the COVID-19 pandemic. Research has focused on understanding acceptance and adoption of these apps, but more work is needed to understand the factors that may contribute to their sustained use. This is key to public health because DCT apps require a high uptake rate to decrease the transmission of the virus within the general population.ObjectiveThis study aimed to understand changes in the use of the National Health Service Test & Trace (T&T) COVID-19 DCT app and explore how public trust in the app evolved over a 1-year period.MethodsWe conducted a longitudinal mixed methods study consisting of a digital survey in December 2020 followed by another digital survey and interview in November 2021, in which responses from 9 participants were explored in detail. Thematic analysis was used to analyze the interview transcripts. This paper focuses on the thematic analysis to unpack the reasoning behind participants’ answers.ResultsIn this paper, 5 themes generated through thematic analysis are discussed: flaws in the T&T app, usefulness and functionality affecting trust in the app, low trust in the UK government, varying degrees of trust in other stakeholders, and public consciousness and compliance dropping over time. Mistrust evolved from participants experiencing sociotechnical flaws in the app and led to concerns about the app’s usefulness. Similarly, mistrust in the government was linked to perceived poor pandemic handling and the creation and procurement of the app. However, more variability in trust in other stakeholders was highlighted depending on perceived competence and intentions. For example, Big Tech companies (ie, Apple and Google), large hospitality venues, and private contractors were seen as more capable, but participants mistrust their intentions, and small hospitality venues, local councils, and the National Health Service (ie, public health system) were seen as well-intentioned but there is mistrust in their ability to handle pandemic matters. Participants reported complying, or not, with T&T and pandemic guidance to different degrees but, overall, observed a drop in compliance over time.ConclusionsThese findings contribute to the wider implications of changes in DCT app use over time for public health. Findings suggest that trust in the wider T&T app ecosystem could be linked to changes in the use of the app; however, further empirical and theoretical work needs to be done to generalize the results because of the small, homogeneous sample. Initial novelty effects occurred with the app, which lessened over time as public concern and media representation of the pandemic decreased and normalization occurred. Trust in the sociotechnical capabilities of the app, stakeholders involved, and salience maintenance of the T&T app in conjunction with other measures are needed for sustained use.

COVID-19 contact tracing apps and the governance of collective action: social nudges, deliberation, and solidarity in Europe and beyond

ABSTRACT During the COVID-19 pandemic, Digital Contact Tracing (DCT) tools were deployed by governments in Europe and beyond as a novel mobile technology to assist traditional manual contact tracing to track individuals who have come in close contact with an infected person. The public debate on this topic focused strongly on the protection of individual privacy. While this debate is important, it fails to address important governance questions – such as, for example, that DCT tools took on the role of social nudges, namely, tools of soft regulation that calibrate information flows so as to “push” people to act in ways that promote collective purposes. Social nudges include a range of norms and values that, however, are built into the technological and social features of the nudge, rather than rendering them open to public scrutiny and debate. Although the use of contact tracing apps is being phased out, the digitization of contact tracing can be seen as a case study of the broader trend towards digitization of the provision of health services. Debates of their governance thus have broader implications for the governance of data driven tools deployed for public health purposes in times of crisis.

#34;You have been in Close Contact with a Person Infected with COVID-19 and you may have been Infected#34;

Through the past two and a half years, COVID-19 has swept through the world and new technologies for mitigating spread, such as exposure notification applications and contact tracing, have been implemented in many countries. However, the uptake has differed from country to country and it has not been clear if culture, death rates or information dissemination have been a factor in their adoption rate. However, these apps introduce issues of trust and privacy protection, which can create challenges in terms of adoptions and daily use. In this paper we present the results from a cross-country survey study of potential barriers to adoption of in particular COVID-19 contact tracing apps. We found that people's existing privacy concerns are an have a reverse correlation with adoption behavior but that the geographical location, as well as other demographics, such as age and gender, do not have significant effect on either adoption of the app or privacy concerns. Instead, a better understanding of what data is collected through the apps lead to a higher level of adoption. We provide suggestions for how to approach the development and deployment of contact tracing apps and more broadly health tracking apps.

COVID-19 contact tracing app reviews reveal concerns and motivations around adoption.

BackgroundGoogle and Apple’s Exposure Notifications System (ENS) was developed early in the COVID-19 pandemic to complement existing contact tracing efforts while protecting user privacy. An analysis by the Associated Press released in December 2020 estimated approximately 1 in 14 people had downloaded apps in states one was available. In this study, we assessed the motivation and experience of individuals who downloaded ENS apps from the Google Play and Apple App Stores.MethodsWe collected review text, star rating, and date of rating for all the reviews on ENS apps in the Google Play and Apple App stores. We extracted the relative frequency of single words and phrases from reviews and created an open vocabulary language, with themes categorized by the research team, to study the salient themes around reviews with high (3–5 stars), neutral (3 stars), and negative (1–2 stars) ratings using logistic regression.ResultsOf 7622 reviews obtained from 26 states between 04/07/2020 to 03/31/2021, 6364 were from Google Play Store, and 1258 were from Apple App Store. We obtained reviews for a total of 38 apps, with 25 apps from the Google Play Store and 13 apps from the Apple Play Store. 78% of the reviews are either 1 star or 5 stars. Positive reviews were driven by ease of use, support for the state government in creating the app, and encouragement for others to download, as well as engage in other COVID-19 precautions. Negative and neutral reviews focused on issues with app functionality (i.e., installation and tracking errors).ConclusionsUptake was the largest barrier to success for ENS apps, but states can use insight from app store reviews to better position themselves if they choose to develop further public health apps.

Comparison of COVID-19 contact-tracing apps in the context of public policy: the cases of Turkey and South Korea

The healthcare systems of almost every country have been facing an unprecedented crisis since the beginning of the COVID-19 pandemic in March 2020. In response, numerous countries have designed and launched their unique applications to inform their citizens about COVID-19 and to follow their health situation. While South Korea has been showing an effective fight against COVID-19, Turkey is one of the most affected ones by the virus. This paper aims to identify key differences and similarities between the contact tracing apps that are used by Turkey and South Korea during COVID-19. In this way, it addresses how two members of the Organization for Economic Co-operation and Development (OECD), one developing (Turkey) and other developed (South Korea) countries, integrated their public policies and crisis management responses with the mobile phone applications and at what scale they are successful. Also, this paper investigates how these differences/similarities between their applications have affected their paths in the pandemic. Comparing their applications, it discusses policy-making processes, technological differences, and contact tracing strategies with policy recommendations for other countries.

Factors Influencing the Willingness to Download COVID-19 Contact Tracing Apps: The Moderating Effect of Persuasive Design and Smartphone Usage Experience

The COVID-19 pandemic culminated in the global roll-out of contact tracing apps, also known as exposure notification apps (ENAs), to contain the spread of the virus. ENAs notify users about a possible infection and advises them to take certain health measures such as self-isolation and COVID-19 test. While some work has been done on the factors that influence ENA adoption, little attention has been paid to the moderating effect of persuasive design and smartphone usage experience. This paper sets out to bridge this gap using the Government of Canada’s official app “COVID Alert” and Canadian non-adopter population (n = 133) as a case study. Of the seven factors we investigated, perceived trust (β = 0.29, p < 0.01) and perceived enjoyment (β = 0.21, p < 0.05) turned out to be the only significant predictors of non-adopters’ willingness to download the app in the overall model. Both persuasive design and smartphone usage experience moderated some of the relationships in the model. For example, while perceived enjoyment is significant in the persuasive design submodel (β = 0.34, p < 0.01) and low-experience submodel (β = 0.36, p < 0.001), it is not in the control design and high-experience submodels. Moreover, perceived enjoyment (β = 0.36, p < 0.001) and privacy concern (β = -0.46, p < 0.05) turned out to be the strongest predictors in the low-experience and high-experience submodels, respectively. These results indicate that, to improve the download of ENAs, sponsors should implement and highlight app features that foster trust in marketing campaigns and app-store descriptions. Particularly, they should highlight their privacy-protection feature and hedonic attribute among the high-experience and low-experience groups, respectively.

Sharing is caring: willingness to share personal data through contact tracing apps in China, Germany, and the US

ABSTRACT Are citizens more willing to share private data in (health) crises? We study citizens’ willingness to share personal data through COVID-19 contact tracing apps (CTAs). Based on a cross-national online survey with 6,464 respondents from China, Germany, and the US, we find considerable variation in how and what data respondents are willing to share through CTAs. Drawing on the privacy calculus theory and the trade-off model of privacy and security, we find that during the COVID-19 pandemic, crisis perceptions seem to have only limited influence on people’s willingness to share personal data through CTAs. The findings further show that the data type to be shared determines the suitability of the privacy calculus theory to explain people’s willingness to transfer personal data: the theory can explain the willingness to share sensitive data, but cannot explain the willingness to share less sensitive data.

Preferences in the Willingness to Download a COVID-19 Contact Tracing App in the Netherlands and Turkey: Experimental Study.

BackgroundDespite the worldwide growth in using COVID-19 contact tracing apps (CTAs) and the potential benefits for citizens, governments, health care professionals, businesses, and other organizations, only a few studies have examined the factors affecting the levels of willingness to download a CTA.ObjectiveThis study aimed to investigate individuals’ preferences in the willingness to download a health app.MethodsWe conducted an experimental study in 2 countries, the Netherlands (N=62) and Turkey (N=83), using 4 different vignettes (ie, data protection, manufacturer, reward, and gaming models) with different attributes. Participants were randomly assigned to 1 of the conditions within the vignettes.ResultsThe results showed that data protection and gaming elements are factors that influence the willingness to download a COVID-19 CTA. More specifically, we see that data protection is an important factor explaining the willingness to download the app in Turkey, whereas including gaming elements significantly affects the willingness to download the app in the Netherlands.ConclusionsCOVID-19 CTAs are highly promising to reduce the spread of the virus and make it easier to open up society faster, especially because they can be used quickly and share information rapidly. COVID-19 CTA developers must ensure that their apps satisfactorily and sufficiently address ethical considerations, even in times of crisis. Furthermore, integrating gaming elements in the CTA could enhance the willingness to download the CTA.

Acceptability of the COVID-19 contact-tracing app – Does culture matter?

During the pandemic, several countries deployed contact-tracing apps in order to contain or reduce the community spread of COVID-19. However, the success rate in terms of acceptance and use of these apps was reportedly low. Using information gathered from citizens across four European countries and the United States of America, this study explores the role of national culture in relation to the acceptance of these apps.Using partial least squares structural equation modelling (PLS-SEM), an analysis was undertaken of 3595 records from a cross-country survey dataset that is in the public domain and can be obtained from the Centre for Open Science (Study 1). This analysis was followed by another survey comprising 910 respondents (Study 2). The research model was then validated by using a qualitative approach and undertaking interviews with 51 participants from four countries (Study 3). The results confirmed the moderating role of national culture on the acceptability of the contact-tracing apps in relation to power-distance, masculinity, individualism, long-term orientation and indulgence in the pre-deployment phase (Study 1). There were, however, no significant differences in acceptability of the apps between countries in relation to uncertainty avoidance; and none of the hypotheses in Study 2 was supported.The study concludes that national culture is significant in terms of the acceptance of COVID-19 apps only during the pre-deployment phase; therefore attention is required with pertinence to pre-deployment strategies. Recommendations regarding how governments and public health institutions can increase the acceptability of contact-tracing apps have been highlighted.

Between surveillance and technological solutionism: A critique of privacy-preserving apps for COVID-19 contact-tracing

In this article, we examine the rise of contact-tracing apps during the first 2 years of the COVID-19 pandemic as a new form of technological solutionism – a technological or techno-social fix that can be deployed at national scale in response to an urgent, supranational problem. A dystopian view saw the rapid development and proliferation of COVID-19 contact-tracing apps as a vanguard technology for surveillance. Expediently deployed as a technological fix to the pandemic, contact-tracing was seen to threaten to transform a state of emergency into a state of exception, under which accepted or constitutional laws and norms might be suspended. Here, we extend early critiques of the contact-tracing app as a ‘technofix’ to argue the growing intervention of global technology corporations in digital governance and affairs of national sovereignty throughout the COVID-19 pandemic represents a new frontier of state–industrial surveillance that exploits people’s pre-investment in and dependence on technology corporations. We exemplify this with the ‘technofix’ of the Google–Apple Exposure Notification (GAEN) framework and critically examine the notion of a decentralised and privacy-preserving Bluetooth-based contact-tracing framework proposed by global technology corporations that may threaten state sovereignty when determining public health responses to current or future crises.

Appsolutely secure? Psychometric properties of the German version of an app information privacy concerns measure during COVID-19.

IntroductionPrivacy concerns are an important barrier to adoption and continued use of digital technologies, particularly in the health sector. With the introduction of mobile health applications (mHealth apps), the construct of app information privacy concerns has received increased attention. However, few validated measures exist to capture said concerns in population samples, although they can help to improve public health efforts.MethodsUsing a cross-sectional survey of German adults (mean age = 35.62; 63.5% female), this study examined psychometric properties of the app information privacy concerns scale (AIPC). Analyses comprised confirmatory factor analysis, factorial validity (exploratory factor analysis), internal consistency, convergent validity (i.e., correlations with privacy victimhood, and app privacy concerns), and discriminant validity (i.e., daily app use, adoption intentions, and attitudes toward COVID-19 contact tracing app use).ResultsThe analysis did not support the proposed three-factor structure of the AIPC (i.e., anxiety, personal attitude, and requirements). Instead, a four-factor model was preferable that differentiated requirements regarding disclosure policies, and personal control. In addition, factors mirroring anxiety and personal attitude were extracted, but shared a significant overlap. However, these factors showed good reliability, convergent and discriminant validity.DiscussionThe findings underline the role of app information privacy concerns as a significant barrier to mHealth app use. In this context, anxiety and personal attitudes seemed particularly relevant, which has implications for health communication. Moreover, the observed differentiation of external (disclosure) and internal (control) requirements aligns with health behavior change models and thus is a promising area for future research.

Drivers of downloading and reasons for not downloading COVID-19 contact tracing and exposure notification apps: A national cross-sectional survey.

BackgroundBluetooth-enabled smartphone apps have been developed and implemented in different sites globally to help overcome capacity limitations of traditional interview-based COVID-19 contact tracing. Two apps are currently available in Canada: ABTraceTogether exclusively in Alberta and COVID Alert in nine other provinces and territories. This study aims to examine factors associated with downloading of these apps to inform targeted promotion and marketing to increase app uptake.MethodsWe performed a cross-sectional survey with adult participants (≥18 years old) from an online national panel. Participants were asked if they had downloaded an app and, if applicable, reasons for not downloading. Logistic regression was used to identify sociodemographic factors and trusted information sources associated with downloading and reasons for not downloading.ResultsOf the included 4,503 respondents (36% response rate), 1,394 (31%) had downloaded an app. Demographic and socioeconomic factors positively associated with app download were: 1) being female, 2) higher household income, 3) higher education level attained, and 4) more liberal political views. The odds of downloading an app were higher for participants who trusted health-related information sources, and lower for those who trusted internet searches, family and friend, or Facebook. The most cited reasons for not downloading were related to data security concerns and perceived lack of benefit from the apps.InterpretationThese findings identify sociodemographic segments with the lowest app uptake, reasons for not downloading and trusted information sources to inform targeted promotion and marketing strategies to improve uptake of apps to facilitate contact tracing.

Adoption of Covid-19 contact tracing app by extending UTAUT theory: Perceived disease threat as moderator

ObjectivesContact tracing applications are technological solutions that can quickly trace and notify users of their potential exposure to the Covid-19 virus and help contain the spread of the disease. However, extant research delineating the various factors predicting the adoption of contact tracing apps is scant. The study's primary objective is to develop and validate a research model based on the unified theory of acceptance and use of technology (UTAUT), health belief model (HBM), perceived privacy risk and perceived security risk to understand the adoption of contact tracing application. MethodsAn online survey was carried out among users of the ‘Aarogya Setu’ contact tracing app in India. The partial least squares structural equation modelling (PLS-SEM) tool was employed to analyze data from 307 respondents. ResultsThe results showed that performance expectancy, social influence, and facilitating conditions positively influenced users’ intention to adopt the app. In contrast, perceived privacy and security risks were significant barriers to app adoption. Perceived disease threat as a moderator mitigated the adverse impact of perceived privacy risk on users' intention to adopt contact tracing apps. ConclusionsThe current study gives insights on both drivers and barriers to the adoption of contract tracing applications. Various theoretical and practical implications of significance are provided for academicians and practitioners to effectively promote app adoption to tackle the Covid-19 pandemic.

Data Management and Privacy Policy of COVID-19 Contact-Tracing Apps: Systematic Review and Content Analysis.

BackgroundCOVID-19 digital contact-tracing apps were created to assist public health authorities in curbing the pandemic. These apps require users’ permission to access specific functions on their mobile phones, such as geolocation, Bluetooth or Wi-Fi connections, or personal data, to work correctly. As these functions have privacy repercussions, it is essential to establish how contact-tracing apps respect users’ privacy.ObjectiveThis study aimed to systematically map existing contact-tracing apps and evaluate the permissions required and their privacy policies. Specifically, we evaluated the type of permissions, the privacy policies’ readability, and the information included in them.MethodsWe used custom Google searches and existing lists of contact-tracing apps to identify potentially eligible apps between May 2020 and November 2021. We included contact-tracing or exposure notification apps with a Google Play webpage from which we extracted app characteristics (eg, sponsor, number of installs, and ratings). We used Exodus Privacy to systematically extract the number of permissions and classify them as dangerous or normal. We computed a Permission Accumulated Risk Score representing the threat level to the user’s privacy. We assessed the privacy policies’ readability and evaluated their content using a 13-item checklist, which generated a Privacy Transparency Index. We explored the relationships between app characteristics, Permission Accumulated Risk Score, and Privacy Transparency Index using correlations, chi-square tests, or ANOVAs.ResultsWe identified 180 contact-tracing apps across 152 countries, states, or territories. We included 85.6% (154/180) of apps with a working Google Play page, most of which (132/154, 85.7%) had a privacy policy document. Most apps were developed by governments (116/154, 75.3%) and totaled 264.5 million installs. The average rating on Google Play was 3.5 (SD 0.7). Across the 154 apps, we identified 94 unique permissions, 18% (17/94) of which were dangerous, and 30 trackers. The average Permission Accumulated Risk Score was 22.7 (SD 17.7; range 4-74, median 16) and the average Privacy Transparency Index was 55.8 (SD 21.7; range 5-95, median 55). Overall, the privacy documents were difficult to read (median grade level 12, range 7-23); 67% (88/132) of these mentioned that the apps collected personal identifiers. The Permission Accumulated Risk Score was negatively associated with the average App Store ratings (r=−0.20; P=.03; 120/154, 77.9%) and Privacy Transparency Index (r=−0.25; P<.001; 132/154, 85.7%), suggesting that the higher the risk to one’s data, the lower the apps’ ratings and transparency index.ConclusionsMany contact-tracing apps were developed covering most of the planet but with a relatively low number of installs. Privacy-preserving apps scored high in transparency and App Store ratings, suggesting that some users appreciate these apps. Nevertheless, privacy policy documents were difficult to read for an average audience. Therefore, we recommend following privacy-preserving and transparency principles to improve contact-tracing uptake while making privacy documents more readable for a wider public.

Applied Ethics and Digital Information Privacy: Informing the Design of Covid-19 Contact Tracing Apps

To counteract the spread of Covid-19, many countries have introduced mobile applications for contact tracing, which raises considerable questions about how these apps protect users’ information privacy. Through an exploratory analysis of Covid-19 contact tracing apps being used in Australia, France, Germany, Japan, and New Zealand, we identify normative and technical principles for the design of privacy-sensitive contact tracing apps. Based on a Restricted Access/Limited Control (RALC) account of information privacy, we discuss how the apps protect users’ information privacy through limiting access to and allowing users to actively manage their personal information. Our findings illustrate what understanding of information privacy is evident from the various designs of Covid-19 contact tracing apps, and how competing design principles can contribute to users’ information privacy. From a practical perspective, our findings can inform the design of contact tracing apps and the development of privacy approaches that can be applied in particular contexts. Our work thus bridges the gap between ethical design guidelines and technical analyses of specific implementations.

The effect of notification window length on the epidemiological impact of COVID-19 contact tracing mobile applications

BackgroundThe reduction in SARS-CoV-2 transmission facilitated by mobile contact tracing applications (apps) depends both on the proportion of relevant contacts notified and on the probability that those contacts quarantine after notification. The proportion of relevant contacts notified depends upon the number of days preceding an infector’s positive test that their contacts are notified, which we refer to as an app’s notification window.MethodsWe use an epidemiological model of SARS-CoV-2 transmission that captures the profile of infection to consider the trade-off between notification window length and active app use. We focus on 5-day and 2-day windows, the notification windows of the NHS COVID-19 app in England and Wales before and after 2nd August 2021, respectively.ResultsOur analyses show that at the same level of active app use, 5-day windows result in larger reductions in transmission than 2-day windows. However, short notification windows can be more effective at reducing transmission if they are associated with higher levels of active app use and adherence to isolation upon notification.ConclusionsOur results demonstrate the importance of understanding adherence to interventions when setting notification windows for COVID-19 contact tracing apps.

One-Time Decision or Continual Adjustment? A Longitudinal Study of the Within-Person Privacy Calculus among Users and Non-Users of a COVID-19 Contact Tracing App

ABSTRACT Privacy behaviors are described to be situationally dynamic. While most privacy studies rely on cross-sectional analyses, it is important to investigate these dynamics within persons. In the present study, we will focus on the adoption of a COVID-19 contact tracing app as this was shown to be a privacy calculus-based decision and the pandemic situation unfolded as highly dynamical. The present longitudinal online panel study (N = 548) investigated users and non-users of this app at three points over a six-month period. Results support dynamical privacy calculus assumptions on the within-subject level: situational privacy concerns were negatively, and situationally perceived benefits and knowledge were positively associated with app adoption. Remarkably, a within-person interaction between concerns and benefits was found. Moreover, the trait need for privacy moderated the relation between perceived benefits and app adoption. Hence, privacy (calculus) decisions seem to be a dynamic and situational rather than a one-time decision.

Modeling Trust in COVID-19 Contact-Tracing Apps Using the Human-Computer Trust Scale: Online Survey Study.

BackgroundThe COVID-19 pandemic has caused changes in technology use worldwide, both socially and economically. This pandemic crisis has brought additional measures such as contact-tracing apps (CTAs) to help fight against spread of the virus. Unfortunately, the low adoption rate of these apps affected their success. There could be many reasons for the low adoption, including concerns of security and privacy, along with reported issues of trust in CTAs. Some concerns are related with how CTAs could be used as surveillance tools or their potential threats to privacy as they involve health data. For example, in Estonia, the CTA named HOIA had approximately 250,000 downloads in the middle of January 2021. However, in 2021, only 4.7% of the population used HOIA as a COVID-19 CTA. The reasons for the low adoption include lack of competency, and privacy and security concerns. This lower adoption and the lack of trustworthiness persist despite efforts of the European Union in building ethics and trustworthy artificial intelligence (AI)-based apps.ObjectiveThe aim of this study was to understand how to measure trust in health technologies. Specifically, we assessed the usefulness of the Human-Computer Trust Scale (HCTS) to measure Estonians’ trust in the HOIA app and the causes for this lack of trust.MethodsThe main research question was: Can the HCTS be used to assess citizens’ perception of trust in health technologies? We established four hypotheses that were tested with a survey. We used a convenience sample for data collection, including sharing the questionnaire on social network sites and using the snowball method to reach all potential HOIA users in the Estonian population.ResultsAmong the 78 respondents, 61 had downloaded the HOIA app with data on usage patterns. However, 20 of those who downloaded the app admitted that it was never opened despite most claiming to regularly use mobile apps. The main reasons included not understanding how it works, and privacy and security concerns. Significant correlations were found between participants’ trust in CTAs in general and their perceived trust in the HOIA app regarding three attributes: competency (P<.001), risk perception (P<.001), and reciprocity (P=.01).ConclusionsThis study shows that trust in the HOIA app among Estonian residents did affect their predisposition to use the app. Participants did not generally believe that HOIA could help to control the spread of the virus. The result of this work is limited to HOIA and health apps that use similar contact-tracing methods. However, the findings can contribute to gaining a broader understanding and awareness of the need for designing trustworthy technologies. Moreover, this work can help to provide design recommendations that ensure trustworthiness in CTAs, and the ability of AI to use highly sensitive data and serve society.

Mobile health technology as a solution to self-control problems: The behavioral impact of COVID-19 contact tracing apps in Japan

RationaleMobile technology has been widely utilized as an effective healthcare tool during the COVID-19 pandemic. Notably, over 50 countries have released contact-tracing apps to trace and contain infection chains. While earlier studies have examined obstacles to app uptake and usage, whether and how this uptake affects users’ behavioral patterns is not well understood. This is crucial because uptake can theoretically increase or decrease behavior that carries infection risks. ObjectiveThe goal of this study is to evaluate the impact of app uptake on the time spent out of home in Japan. It tests four potential underlying mechanisms that drive the uptake effect: compliance with stay-at-home requirements, learning about infection risk, reminders, and commitment device. MethodWe use unique nationwide survey data collected from 4,379 individuals aged between 20 and 69 in December 2020 and February 2021 in Japan. Japan has features suitable for this exercise. The Japanese government released a contact tracing app in June 2020, which sends a warning message to users who have been in close contact with an infected person. We conduct a difference-in-differences estimation strategy combined with the entropy balancing method. ResultsApp uptake reduces the time spent out of home. Sensitivity analysis shows that it cannot be explained by unobserved confounders. Importantly, the impact is large even among users who have not received a warning message from the app, and even larger for those with poor self-control ability. Furthermore, individuals’ self-control ability is negatively associated with the uptake decision, supporting our hypothesis that the apps serve as a commitment device. ConclusionsIt may be beneficial to encourage citizens to uptake contact tracing apps and other forms of commitment devices. This study also contributes to the literature on mobile health (mHealth) by demonstrating its efficacy as a commitment device.