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Public attitudes towards COVID-19 contact tracing apps: a UK-based focus group study
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Abstract
OBJECTIVE: To explore public attitudes to the proposed COVID-19 contact tracing app in the United Kingdom.DESIGN: Qualitative study consisting of five focus groups carried out between 1st-4th May, 2020 (39-42 days after the official start of the UK lockdown). SETTING: Online video-conferencingPARTICIPANTS: 22 participants, all UK residents aged 18 years and older, representing a range of different genders, ages, ethnicities and locations.RESULTS: Participants were split roughly equally in number across three groups: will use the app; will not be using the app; and undecided as to whether they will use the app. Analysis revealed five main themes: (1) Lack of information and misconceptions surrounding COVID-19 contact tracing apps; (2) concerns over privacy; (3) concerns over stigma; (4) concerns over uptake; and (5) contact tracing as the ‘greater good’. These themes were found across the sample and the three groups. However, concerns over privacy, uptake and stigma were particularly significant amongst those state they will not be using the app and the view that the app is for the “greater good” was particularly significant amongst those who stated they will be using the app. One of the most common misconceptions about the app was that it could allow users to specifically identify and map COVID-19 cases amongst their contacts and in their vicinity.CONCLUSIONS: We offer four recommendations: (1) To offset the fact that many people may not be accessing, or might be avoiding, news coverage on COVID-19, authorities must communicate to the public via a range of methods including but not limited to: social media ads, postal information, text messaging and other emergency alert systems. (2) Communications should emphasise that the app cannot enable the user to identify which of their contacts has reported COVID-19 symptoms or tested positive. (3) Communication should emphasise collective responsibility (‘the greater good’) to promote social norms around use of the app (4) Communication should provide a slogan that maximises clarity of message, for example: ‘Download the app, protect the NHS, save lives’.
... Concentrates on survey or focus group methods for data collection (eg, user acceptability of a contact tracing app [49]) ...
... An easy system for reporting technical difficulties and a minimally disruptive evaluation of other app functionalities may therefore increase use. Moreover, since one main barrier to app uptake is privacy and data security concerns [21][22][23]27,29,49,75,76], users can be empowered by designs that use customizable app functionalities. For example, app users could be offered choices in the technology used to collect the data (GPS or Bluetooth), how the data is stored [77], and the level of interaction with local health agencies. ...
Background:
Given the magnitude and speed of SARS-CoV-2 transmission, achieving timely and effective manual contact tracing has been a challenging task. Early in the pandemic, contact tracing apps generated substantial enthusiasm due to their potential for automating tracing and reducing transmission rates while enabling targeted confinement strategies. However, although surveys demonstrate public interest in using such apps, their actual uptake remains limited. Their social acceptability is challenged by issues around privacy, fairness, and effectiveness, among other concerns.
Objective:
This study aims to examine the extent to which design and implementation considerations for contact tracing apps are detailed in the available literature, focusing on aspects related to participatory and responsible eHealth innovation, and synthesize recommendations that support the development of successful COVID-19 contact tracing apps and related eHealth technologies.
Methods:
Searches were performed on five databases, and articles were selected based on eligibility criteria. Papers pertaining to the design, implementation, or acceptability of contact tracing apps were included. Articles published since 2019, written in English or French, and for which the full articles were available were considered eligible for analysis. To assess the scope of the knowledge found in the current literature, we used three complementary frameworks: (1) the Holistic Framework to Improve the Uptake and Impact of eHealth Technologies, (2) the Montreal model, and (3) the Responsible Innovation in Health Assessment Tool.
Results:
A total of 63 articles qualified for the final analysis. Less than half of the selected articles cited the need for a participatory process (n=25, 40%), which nonetheless was the most frequently referenced item of the Framework to Improve the Uptake and Impact of eHealth Technologies. Regarding the Montreal model, stakeholder consultation was the most frequently described level of engagement in the development of contact tracing apps (n=24, 38%), while collaboration and partnership were cited the least (n=2, 3%). As for the Responsible Innovation in Health framework, all the articles (n=63, 100%) addressed population health, whereas only 2% (n=1) covered environmental considerations.
Conclusions:
Most studies lacked fundamental aspects of eHealth development and implementation. Our results demonstrate that stakeholders of COVID-19 contact tracing apps lack important information to be able to critically appraise this eHealth innovation. This may have contributed to the modest uptake of contact tracing apps worldwide. We make evidence-informed recommendations regarding data management, communication, stakeholder engagement, user experience, and implementation strategies for the successful and responsible development of contact tracing apps.
... 6 Despite apps launching across the globe, some ascribe lack of widespread adoption to privacy concerns. [7][8][9][10][11] Communicating an app's security through public service announcements (PSAs) has the potential to alleviate those concerns. ...
Introduction
Digital contact tracing smartphone apps have the potential to slow the spread of disease but are not widely used. We tested whether messages describing how a COVID-19 digital contact tracing app protects users’ privacy led to increased or decreased intentions to download the app by either calming privacy concerns or increasing their saliency.
Methods
We recruited adult smartphone owners in the U.S. (oversampled for younger adults aged 18-34 years) in November 2020 through an online panel. Survey software randomly assigned 860 participants to one of two parallel messaging conditions (n=430 privacy assured; n=430 no privacy described).
Results
After removing incompletes, those who failed the manipulation checks, or who had already downloaded a COVID-19 digital contact tracing app, we analyzed 671 participants (n=330 privacy; n=341 no privacy) in 2021. There was no relationship between privacy condition and download intention (Mprivacy=2.69, Mnoprivacy=2.69, b=0.01, 95%CI=[-0.13, 0.15], p=.922), but also no evidence that describing the app's security increased context-dependent privacy concerns (measured three ways). Instead, we found increased endorsement of data security in the privacy condition using a scale of beliefs about the app keeping privacy secure (Mprivacy=2.74, Mnoprivacy=2.58, b=0.16, 95%CI=[0.04, 0.28], p=.009, small effect (ω²=.009)).
Conclusions
This study provides some evidence that people developing contact tracing messaging campaigns do not need to worry that describing a digital contact tracing app's privacy protections will backfire. Future mixed methods testing of messages about who has access to information—and for how long—may uncover new communication strategies to increase public trust in contact tracing apps.
Trial registration
AsPredicted#51826
Background:
The COVID-19 pandemic stimulated the availability and use of population and individual health data to optimise tracking and analysis of the spread of the virus. Many health care services have had to rapidly digitalise in order to maintain the continuity of care provision. Data collection and dissemination have provided critical support to defence against the spread of the virus since the beginning of the pandemic; however, little is known about public perceptions of and attitudes towards the use, privacy, and security of data.
Objective:
The goal of this study is to better understand people's willingness to share data in the context of COVID-19.
Methods:
A web-based survey was conducted, looking at individuals' use of and attitudes toward health data for those 18 years and older, and in particular, with a reported diagnosis of a chronic health condition placing them most 'at risk' of severe COVID-19.
Results:
In total, 4,764 individuals responded to this web-based survey. 4,674 (98.1%) reported a medical diagnosis of at least 1 health condition (average 4 per person), with type 2 diabetes (2,974, 62.7%), hypertension (2,147, 45.2%) and type 1 diabetes (1,299, 27.4%) being most prominent in our sample. In general, more people are comfortable with sharing anonymised data than personally identifiable data. People reported feeling comfortable sharing data that were able to benefit others; 66% (3,121 respondents) would share personal identifiable data if its primary purpose was deemed beneficial for the health of others. Almost two-thirds (3,026; 63.9%) would consent to sharing personal, sensitive health data with government or health authority organisations. Conversely, over a quarter of respondents (1,297, 27.8%) stated they did not trust any organisation to protect their data and 54% (2,528) reported concerns about the implications of sharing personal information. Almost two-thirds (3,054, 65%) of respondents were concerned around the provisions of appropriate legislation that seeks to prevent data misuse and hold organisations accountable in the case of data misuse.
Conclusions:
Although our survey focused mainly on the views of those living with chronic health conditions, the results indicate that data sensitivity is highly contextual. More people are more comfortable with sharing anonymised data than personally identifiable data. Willingness to share data also depended on the receiving body, highlighting trust as a key theme, in particular who may have access to shared personal health data and how they may be used in the future. The nascency of legal guidance in this area suggests a need for humanitarian guidelines for data responsibility during disaster relief operations such as pandemics, and for involving the public in their development.
Clinicaltrial:
Background:
Many countries remain in the grip of the COVID-19 global pandemic with a considerable journey still ahead to emerge into a semblance of normality and freedom. Contact tracing smartphone apps are among a raft of measures introduced to reduce spread of the virus but their uptake depends on public choice.
Objective:
The objective of this study was to ascertain the views of citizens in Wales on their intended use of a COVID 19 contact tracing smartphone app, including self-proposed reasons for or against, and what could lead to a change of decision.
Methods:
We distributed an anonymous survey among 4,000 HealthWise Wales participants in May 2020. We took a mixed-methods approach: responses to closed questions were analysed using descriptive and inferential statistics; open question responses were analysed and grouped into categories.
Results:
A total of 976 (24.4%) people completed the survey. Smartphone usage was 91.5% overall, but this varied between age groups. 97.1% were aware of contact tracing apps, but only 67.2% felt sufficiently informed. 55.7% intended to use an app, 23.3% said no, and 21.0% were unsure. The top reasons for app use were: controlling the spread of the virus, mitigating risks for others and self, and increasing freedoms. The top reasons against were: mistrusting the government, concerns about data security and privacy, and doubts about efficacy. The top response for changing their mind about app use from willing to unwilling was that nothing would. This was also the case for unwilling to willing. Among the unsure, it was the need for more information.
Conclusions:
Respondents demonstrated a keenness to help themselves, others, society and government to avoid the virus and to control its spread. However, digital inclusion varied among age groups, precluding participation for some people. Even so, unwillingness was significant and considering the nature of the concerns raised, and the perceived lack of information, policy and decision-makers need to do more to act openly, increase communications and demonstrate trustworthiness if members of the public are to be confident in using an app.
Clinicaltrial:
Background:
Smartphone-based apps designed and deployed to mitigate the COVID-19 pandemic may become an infrastructure for post-pandemic public health surveillance in the United States. Through the lenses of privacy concerns and user expectations of digital pandemic-mitigation techniques, we identify possible long-term sociotechnical implications of such an infrastructure.
Objective:
We explore how people in the United States perceive the possible routinization of pandemic-tracking apps for public health surveillance in general. Our interdisciplinary analysis focuses on the interplay between privacy concerns, data practices of surveillance capitalism, and trust in healthcare providers. We conducted this analysis to achieve a richer understanding of the sociotechnical issues raised by the deployment and use of technology for pandemic mitigation.
Methods:
We conducted scenario-based, semi-structured interviews (n = 19) with adults in the United States. The interviews focused on how people perceive the short- and long-term privacy concerns associated with a fictional smart-thermometer app deployed to mitigate the "outbreak of a contagious disease." In order to elicit future-oriented discussions, the scenario indicated that the app would continue functioning "after the disease outbreak has dissipated." We analyzed interview transcripts using reflexive thematic analysis.
Results:
In the context of pandemic-mitigation technology, including app-based tracking, people perceive a core trade-off between public health and personal privacy. People tend to rationalize this trade-off by invoking the concept of, 'the greater good.' The interplay between the trade-off and rationalization forms the core of sociotechnical issues that pandemic-mitigation technologies raise. Participants routinely expected that data collected through apps related to public health would be shared with unknown third parties for the financial gain of the app makers. This expectation suggests a perceived alignment between an app-based infrastructure for public health surveillance and the broader economics of surveillance capitalism. Our results highlight unintended and unexpected sociotechnical impacts of routinizing app-based tracking on post-pandemic life, which are rationalized by focusing on a nebulous concept of the greater good.
Conclusions:
While technologies such as app-based tracking could be useful for pandemic mitigation and preparedness, the routinization of such apps as a form of public health surveillance may have broader, unintentional sociotechnical implications for individuals and the societies in which they live. Although technology has the potential to increase the efficacy of pandemic mitigation, it exists within a broader network of sociotechnical concerns. Therefore, it is necessary to consider the long-term implications of pandemic-mitigation technologies beyond the immediate needs of addressing the COVID-19 pandemic. Potential negative consequences include the erosion of patient trust in health care systems and providers, grounded in concerns about privacy violations and overly broad surveillance.
Clinicaltrial:
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