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A National Survey of attitudes to COVID-19 Digital Contact Tracing in the Republic of Ireland

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A National Survey of attitudes to COVID-19 Digital Contact Tracing in the Republic of Ireland

Abstract

Background: Contact tracing remains a critical part of controlling the spread of COVID-19. Many countries have developed novel software applications (Apps) in an effort to augment traditional contact tracing methods. Aim: To conduct a national survey of the Irish population to examine barriers and levers to the use of a contact tracing App. Methods: Adult participants were invited to respond via an online survey weblink sent via email and messaging Apps and posted on our university website and on popular social media platforms. Results: A total of 8,088 responses were received, with all 26 counties of the Republic of Ireland represented. 54% of respondents said they would definitely download a contact tracing App, while 30% said they would probably download a contact tracing App. 95% of respondents identified at least one reason for them to download the App, with the most common reasons being the potential for the App to help family members and friends and a sense of responsibility to the wider community. 59% identified at least one reason not to download the App, with the most common reasons being fear that technology companies or the government might use the App technology for greater surveillance after the pandemic. Conclusion: Irish citizens surveyed express high levels of willingness to download a public health-backed App to augment contact tracing. Concerns raised regarding privacy and data security will be critical if the App is to achieve the large-scale adoption and ongoing use required for its effective operation.
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A National Survey of attitudes to COVID-19 Digital
Contact Tracing in the Republic of Ireland
Michael Edmund O'Callaghan ( mike.ocallaghan@ul.ie )
University of Limerick, Ireland https://orcid.org/0000-0002-8450-186X
Jim Buckley
University of Limerick, Ireland
Brian Fitzgerald
University of Limerick, Ireland
Kevin Johnson
University of Limerick, Ireland
John Laffey
National University of Ireland, Galway
Bairbre McNicholas
National University of Ireland, Galway
Bashar Nuseibeh
University of Limerick, Ireland
Derek O'Keeffe
National University of Ireland, Galway
Ian O'Keeffe
University of Limerick, Ireland
Abdul Razzaq
University of Limerick, Ireland
Kaavya Rekaner
University of Limerick, Ireland
Ita Richardson
University of Limerick, Ireland
Andrew Simpkin
National University of Ireland, Galway
Cristiano Storni
University of Limerick, Ireland
Damyanka Tsvyatkova
University of Limerick, Ireland
Jane Walsh
National University of Limerick, Ireland
Thomas Welsh
University of Limerick, Ireland
Liam Glynn
University of Limerick, Ireland
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Research Article
Keywords: coronavirus, COVID-19, contact tracing, App, online survey, public opinion
DOI: https://doi.org/10.21203/rs.3.rs-40778/v1
License: This work is licensed under a Creative Commons Attribution 4.0 International License.Read Full
License
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Abstract
Background: Contact tracing remains a critical part of controlling the spread of COVID-19. Many countries have
developed novel software applications (Apps) in an effort to augment traditional contact tracing methods.
Aim: To conduct a national survey of the Irish population to examine barriers and levers to the use of a contact
tracing App.
Methods: Adult participants were invited to respond via an online survey weblink sent via email and messaging
Apps and posted on our university website and on popular social media platforms.
Results: A total of 8,088 responses were received, with all 26 counties of the Republic of Ireland represented. 54%
of respondents said they would denitely download a contact tracing App, while 30% said they would probably
download a contact tracing App.
95% of respondents identied at least one reason for them to download the App, with the most common reasons
being the potential for the App to help family members and friends and a sense of responsibility to the wider
community. 59% identied at least one reason not to download the App, with the most common reasons being
fear that technology companies or the government might use the App technology for greater surveillance after the
pandemic.
Conclusion: Irish citizens surveyed express high levels of willingness to download a public health-backed App to
augment contact tracing. Concerns raised regarding privacy and data security will be critical if the App is to
achieve the large-scale adoption and ongoing use required for its effective operation.
Introduction
Until a vaccine or ecacious treatment emerge, the key to limiting the harm caused by severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) and its associated disease (COVID-19), is to identify and quarantine
infected individuals as quickly as possible. China and neighbouring countries have shown that an aggressive
public health response involving rapid isolation of infected people and their close contacts can help contain the
virus, thus reducing the number of patients requiring hospital-level care at any one time [1,2]. Asymptomatic and
pre-symptomatic spread of COVID-19 further underlines the importance of timely and effective contact tracing
[3,4].
Given the scale and gravity of the problem, novel software applications (“Apps”) that can potentially simplify the
laborious work of contact tracing are a tempting prospect [5]. These Apps use modern smartphone technology to
record details of other smartphones in the user’s vicinity, record smartphone location, or both, to determine the
recent contacts of those who subsequently test positive for the virus [6]. Whilst the evidence for contact tracing
Apps is limited, in a global pandemic with a novel virus many countries have designed and deployed Apps before
their ecacy can be proven [7].
Researchers from the University of Oxford have estimated that if 56% of people were to download an ideal
contact tracing App in the UK, this would be enough to control the disease by itself [8]. However, the authors
clearly state in the same document “lower numbers of App users will also have a positive effect.” Indeed, the
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designers of Singapore’s TraceTogether App state that these Apps should be viewed as an adjunct to a human-
fronted process and not a panacea to end the pandemic [9].
The technological and privacy challenges associated with such Apps are considerable, and there is much for
governments and public health bodies to consider [10,11]. The announcement of the “Exposure Notication
Application Programming Interface (API) as a joint venture by software companies Google and Apple on 20th May
2020 introduces a more direct means to access the Bluetooth technology harnessed by earlier Apps [12,13]. The
Irish government have committed to building a free-to-download, free-to-use Irish contact tracing App based on
the Exposure Notication API. The initial specication document states that anyone will be able to use the App if
they have a smartphone that is “less than 5 years old” [14].
It remains unclear what proportion of a population must use a contact tracing App for it to make an effective
contribution to a COVID-19 response. It will be dependent on many factors, including the App’s technological
ecacy and the burden of COVID-19 in communities. However, what is clear is that any contact tracing App
solution can only be effective if it is trusted, downloaded and used by a signicant number of citizens. The more
people that download and use the App, the more the number of contacts between people will be silently logged by
the App.
This study aims to gather evidence from the general public via an online survey concerning contact tracing Apps
and relevant barriers citizens of the Republic of Ireland (RoI) consider important to the adoption of such
technologies. Whilst a pandemic of this scale has not been witnessed for more than a century, this is the third
worrying outbreak of a potentially lethal coronavirus in the past 20 years [15]. How long countries will have to
ght to suppress COVID-19 is unknown, yet it is likely that lessons learned from this pandemic, including those
around use of technology, will prove useful for future infectious disease outbreaks.
Objective
The aim of this research is to conduct a national online survey with a large sample of the Irish population to
examine barriers and levers to the use of a contact tracing App to aid in the suppression of the COVID-19
pandemic.
Methods
A 37-item online survey was designed and piloted by researchers at the University of Limerick Graduate Entry
Medical School (GEMS), Science Foundation Ireland Research Centre for Software (LERO) and the National
University of Ireland Galway (NUIG) College of Medicine, Nursing and Health Sciences.
The nal survey (see Appendix 1) was released via Qualtrics XM survey software [16] and featured ve questions
adapted from the Imperial College London “Public Response to UK Government Recommendations on COVID-19”
population survey [17] and four questions adapted from the Oxford University survey of acceptability of a contact
tracing App [18].
The survey was released through social media platforms (Twitter, Facebook, LinkedIN and Instagram), the
University of Limerick website, University emailing lists and via WhatsApp Messenger group conversations on
Friday 22nd May at 12pm. The survey was live for seven days and respondents were advised they needed to be
aged 18 or older when taking the survey.
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In light of the potential for self-selection bias of respondents more familiar with technology, respondents were
encouraged to discuss the survey with friends and family so that the survey could be completed on behalf of
another person who may not be a regularly online. The survey was carried out during the rst week of easing of
widespread societal restrictions which had been in place in the RoI for the previous 10 weeks.
Ethical approval for this project was granted by the University of Limerick Education and Health Sciences (EHS)
ethics committee [study ID 2020_04_18_EHS (ER), approved 21st May 2020].
Statistical Analysis
All analyses were carried out in R v3.6 [19]. Descriptive statistics are used to present the ndings of demographics
and attitudes of the respondents to the COVID-19 crisis, contact tracing and the relevant technologies.
For the primary measure of interest, willingness to download the App, the survey data were weighted by gender
and education to better reect the Irish population. The population distribution of gender (50% male and female)
and education (42% tertiary, 45% secondary, 13% primary or no formal education) were taken from census data
recorded by the Central Statistics Oce of Ireland [20].
We report univariate summaries of key survey questions, with the primary response being willingness to install the
App. Chi-squared tests for association were carried out to investigate whether gender, age group, education level
or level of worry regarding COVID-19 were related to willingness to install.
Results
A total of 8,088 complete responses were recorded. Just 27 responses were returned on behalf of others.
Responses were received from all 26 counties in the Republic of Ireland, with most responses received from the
major population centres of Dublin, Cork, Limerick and Galway. The median age of respondents was 39yrs, mean
age was 41yrs. Eighty-one percent of respondents were female. Regarding highest educational attainment, 7,124
(87%) of respondents reported having a 3rd level qualication.
Overall physical and mental health was reported to be “very good” by 4,249 (53%) respondents, whilst 3,208 (40%)
felt their health was “moderately good”. Regarding chronic disease, 2,519 (31%) of respondents indicated they
had at least one chronic health issue. SARS-CoV-2 related anxiety in the previous week was assessed, with 878
(11%) of respondents reporting they had been “very worried”, while 4,588 (57%) were “moderately worried”.
When asked about contact tracing, 7,929 (98%) respondents understood the concept, while 7,770 (96%) agreed
they would tell public health doctors where they had been and who they had met recently, if it was important to
stop the spread of COVID-19.
Just 6 respondents indicated they do not own a mobile phone. Of the mobile phone owners, 8,036 (98%) own a
smartphone and 7,863 (98%) of these respondents had downloaded an App before and 7,781 (97%) stated that
they would not need help to download an App to their smartphone. Just over two-thirds (68%) of smartphone
owners indicated they keep their phones "very close by (e.g. in pocket, bag or on the desk) all the time". A further
2,211 (28%) indicated they keep their smartphones "very close by (e.g. in pocket, bag or on the desk) more than
50% of the time".
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The majority of respondents (7,757 or 96%) indicated they understand what Bluetooth technology is used for and
7,921 (98%) know how to turn on this function on their phone. Fifty-ve percent of respondents (4,444) stated that
they believed Bluetooth adversely affects device battery life. Bluetooth use was common amongst owners of
smartphones, with 4,995 (63%) using it “Everyday” or “Most days”.
Use of geolocation technology was reported by 7,026 (89%) of smartphone users. Of smartphone users, 5,931
(75%) would be willing to allow the App to access the geolocation capabilities of their phone.
Respondents were asked to select from a list of options reasons that would encourage them to install the App
(see Table 1). In rank order, 6,395 (79%) felt the App would “help protect my family and friends”, 6,338 (78%) felt
“a sense of responsibility to the wider community” while 5,725 (71%) felt it would “let me know my risk of being
infected”. Additional free text responses included “if the App was shown to be effective” and “if it was shown to
be secure”.
Table 1- Barriers/Levers encouraging and discouraging App download
While 3,335 (41%) of respondents could see no reason not to install the App, the remaining 59% of respondents
selected at least one option from a list of 10 options. “I worry technology companies will use this as an excuse for
greater surveillance after the pandemic” was selected by 3,342 (41%) respondents, “I worry the government would
use this as an excuse for greater surveillance after the pandemic” was selected by 2,636 (33%) people and “I
worry that my phone would be more likely to get hacked” was selected by 1,742 (22%) of respondents.
In terms of preference for choice of the App technology, 3,907 (48%) of total respondents stated it did not matter
to them. For the 4,181 who expressed a preference, 1,569 (38% of this group) preferred a Bluetooth-only App,
1,344 (32%) were unsure, 738 (18%) would like an App that uses Bluetooth and Geolocation technology and 530
(13%) would like to see a Geolocation-only App.
Weighted analyses
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Initially 58% percent of respondents indicated they “denitely will install” the App, with a further 25% indicating
they “probably will install” the App. Eight percent indicated they “may or may not install”, 3% indicated they
“probably won’t install” while 6% stated they “denitely won’t install” the App. Following several questions
containing more detailed information about the technologies involved in contact tracing Apps and some potential
push and pull factors regarding adoption (see Table 1), 54% of respondents indicated they “denitely will install”
the App, 30% indicated they “probably will install” the App and 7% indicated they “may or may not install” the App.
Selection of the two remaining options for this question did not change.
There is evidence for an association between gender and unwillingness to install the App, with males more likely
to respond that they probably or denitely won’t install the app (11% vs 6% in females). There is also evidence for
an association with age group, with the oldest and youngest groups most likely to indicate they probably or
denitely will install the App. Finally, COVID related worry was associated with willingness to install – those “Not
At All Worried” about COVID were far more likely to respond that they “denitely won’t install” the App (34% vs 6%
or lower in those more worried about COVID).
Table 2- Participant demographics, Educatio n, COVID-rel ated worry and Health Self-Report versus Final Intention to Download HSE Contact
Tracing App – Unweighted Totals and Weighted Response s shown.
Discussion
Summary of main ndings
This survey has found considerable willingness amongst Irish citizens to download a public health service-
endorsed COVID-19 contact tracing App. It was an acceptable intervention to a large majority (82%) of our
sample. This did not alter signicantly following mention of the type of technology involved, or issues
surrounding tracing of close contacts or location data.
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Our sample was heavily skewed toward female participants, those with higher educational attainment and the 18-
29yrs and 30-41yrs age groups were overrepresented when compared to the Irish population. This is partly
explained by our survey invitation gaining traction with the online “followers” of a popular female Irish general
practitioner who encouraged completion of the survey. This single endorsement led to almost 3,000 responses
being received from young females in a 24-hour period. However, weighting for gender did not signicantly
change the primary outcome measure of willingness to download the App. Forty-two percent of Irish citizens
possess a third level qualication, compared to 82% of our cohort. Higher educational attainment has an age
gradient in Ireland [20] and thus this may be partly explained by the fact our sample was younger than the
population, yet likely also reects our chosen methodology where participants were primarily recruited using
online platforms.
Ninety-two percent of our cohort reported good or very good health, which is greater than the 84% seen in the
Healthy Ireland survey report 2019 [23]. Regarding chronic disease, 69% of our cohort reported no chronic illness,
which is in line with the 68% reported in the Health Ireland survey. Poorer self-reported health status did not
translate to increased willingness to download a contact tracing App. Indeed, those with “very good” health were
most likely to “denitely” download the App. However, respondents’ level of worry about COVID-19 in the past
week did inuence expressed willingness to download the App. Whilst 2% of those “Very Worried” about COVID-19
would denitely not install the App, 38% of the 478 respondents “Not At All Worried” about COVID-19 said they
denitely would not install the App. This may be a relevant area for public awareness campaigns when the Irish
App is released.
Smartphone ownership of 98% is higher than the 91% reported in the 2019 Global Mobile Consumer Survey [24]
and may be explained by the ease with which online surveys can be taken using a smartphone’s Internet browser.
That 96% of respondents keep their phone very close by more than 50% of the time is important if detection of a
smartphones Bluetooth signal by the App will act a proxy for its owner’s precise location.
Whilst a number of responses were received from people aged 65 and above (563 (7%)), very few responses were
received on behalf of other people. It was hoped to capture more opinions from less technologically-adept citizens
in this survey by encouraging respondents to discuss it with friends and family. Of the people aged 65 and above,
14% were very worried about COVID-19, 91% had a smartphone and 91% said they would probably or denitely
install the contact tracing App.
While selection bias and other sampling issues inherent in online surveys are well described, online survey
methods are quick and can be used to reach a wide audience [21, 22]. The latter characteristics of online surveys
were attractive in the early stages of this pandemic and have allowed us to quickly inform a national discussion
concerning the Irish contact tracing App. However, planned qualitative work will be critical to gather opinions and
attitudes of underrepresented and hard to reach cohorts if App deployment is to avoid a digital divide that mirrors
well established socioeconomic patterns of engagement with the healthcare system.
A good level of knowledge of Bluetooth technology and prior use of Bluetooth technology was reported by the
majority of our respondents. However, if the Google/Apple Exposure Notication API bypasses the manual step of
turning on Bluetooth and enabling the App to access it, these ndings may not be as relevant. A large portion
(3907 (48%)) of respondents indicated they had no preference for the technology the Irish contact tracing App
uses. However, an App featuring geolocation technology was only preferred by 16% of respondents. One quarter
of respondents indicated they would not permit a contact tracing App to access geolocation data. While fully
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anonymised geolocation data in the context of the COVID-19 pandemic is not likely to cause any data protection
issues per se [25], it may hinder adoption of the App among some cohorts of the population, particularly given the
types of barriers described in Table 1.
Strengths and Limitations
This study captured data from a large sample of the general public in the Republic of Ireland using an online
survey tool. However, our sample comprised a higher proportion of smartphone owners than is seen nationally
and selection bias effects regarding more technologically adept citizens is a potential limitation. If those taking
part in this study are more or less likely to download the App compared to those who did not take part, then
willingness to download at a population level may be different to this study’s estimates. Given the nature of the
online survey, our results may represent an upper bound for willingness to install the app. Additionally, our sample
was younger than the Irish population, comprised more females and had a higher level of educational attainment
than the Irish population. However, given the size of our sample, weighting to resolve these sampling issues was
possible and did not signicantly alter our main ndings (see Table 2).
Implications for research and practice
It seems that the primary driver for people’s willingness to download a public health backed contact tracing App
during the current crisis is a desire to help others and “for the greater good”. Forty-one percent of our sample did
not feel any of our presented options would dissuade them from downloading the App (see Table 1). However,
privacy issues and worries regarding technology companies, governments and hackers capitalizing on perceived
security weaknesses resulting from such an App were expressed by many respondents. Plans to release the
source code of the Irish contact tracing App are welcome and may help reassure people in this regard [14].
Analysis of free text responses yielded interesting insights and suggestions for the App. Some respondents stated
that they would be more likely to install the App if there was clear evidence that it was effective. There were also
several technology-based suggestions for the App. Battery life concerns led some respondents to suggest
integrating a feature which automatically enables Bluetooth when the user leaves their primary residence or
workplace (e.g. the App is activated when the phone is disconnected from home or work Wi-Fi). Another
suggestion involves pre-setting times for the App to be active, which correspond with their work, travel or
shopping schedule in an effort to conserve battery life. Finally, use of Bluetooth Low Energy technology (BLE)
technology where possible may be another worthwhile feature.
Assessing willingness to download contact tracing Apps has been estimated by large surveys in the UK, Italy,
Germany, France and the US. In keeping with our study, 75% of respondents in these countries indicated
comparable willingness to download a similar contact tracing App [26]. How intent to download translates to
actual downloads and ongoing use remains to be seen as contact tracing Apps in the countries listed above are
all in development or in early stages of deployment.
However, Singapore deployed their TraceTogether App in late March and 10 weeks later, as of early June, 28% of
Singaporeans have downloaded the App [27]. In Australia, 64% of respondents in a large survey conducted in
early April stated they would download a Bluetooth tracking App [28]. Follow up survey by the same research
group 12 days after launch of the Australia “COVIDSafe” App established that 44% of respondents had
downloaded the App [29]. Of respondents who downloaded the App, 1 in 10 were not using it. At a population
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level, it is estimated that approximately six million Australians (20% of the population) have downloaded the
COVIDSafe App [30]. Iceland is considered to have had the most successful adoption of a national contact
tracing App, and currently almost 40% of their population of 340,000 have voluntarily downloaded the Rakning-19
App [31,32]. China and India have made use of COVID-19 Apps mandatory [33] but it is unlikely western
democracies will opt for this strategy.
Each country’s response thus far to COVID-19 is so varied, from testing to media reporting, that it is no surprise
that a one-size-ts-all approach is unlikely to exist for COVID-19 Contact Tracing Apps. There are a number of
technological issues that are likely to negatively impact on download and usage rates. The App being developed
for the Republic of Ireland will only work on newer smartphones and all smartphone users will need to update
their operating system to install the new API being developed by Google/Apple. Each of the barriers described
here presents an additional hurdle for an undetermined proportion of the population, and each will lead to
incremental reductions in App usage.
Conclusion
To date, the international evidence for contact tracing Apps remains limited. Despite this, our study indicates a
signicant majority of the Irish general public are currently willing to download an App which aims to augment
our existing contact tracing process. Issues raised around privacy, data protection and some mistrust of
technology companies and government remind us that any App will need to have transparency at its core and
dened timelines for operation.
App download and ongoing use are two separate challenges, and to ensure both occur it will be important to
generate evidence that this App is useful to our country’s contact tracing efforts. While it is dicult to quantify the
benet of a single measure when several measures are simultaneously active, it may be benecial to keep the
public informed on key data relating to the App, including downloads, active users and numbers of cases where
the App has helped contact tracing efforts as a method of promoting adoption and ongoing use. People have
indicated a clear willingness to help but experience from other countries shows that such willingness does not
always translate into action. Allowing the general public to see in real-time the public health benets of this App
may help promote the App and maintain public interest.
Irish citizens surveyed are very familiar with Bluetooth technology and expressed a preference for Bluetooth-
based App rather than a geolocation based App. Given this, and the additional data protection concerns
associated with geolocation data [34], the plans for the Irish App to use Bluetooth technology are likely to be more
acceptable to the Irish public. However, messaging around privacy, data protection and the role that the
Google/Apple API plays in the App design will be important. Our results also suggest public health campaigns
encouraging use of the App should focus on the key messages of the seriousness of COVID-19 disease and
around the benet to family, friends and communities of reducing COVID-19 spread.
Data from other countries suggest a signicant response to contact tracing Apps by early adopters, followed by a
swift plateauing in the population. In addition, as countries continue to reduce transmission and overall
healthcare burden from COVID-19 effectively, general societal concern is likely to decline. However, with the
considerable uncertainty that prevails with the COVID-19 pandemic and the likelihood of further outbreaks, it
seems prudent for all countries to continue contact tracing App development.
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Note- The authors of this study plan to repeat this survey after the App being developed has been deployed in the
Republic of Ireland.
Declarations
Funding- This research work is supported by a funding grant from Science Foundation Ireland. Project ID:
20/COV/0133.
Acknowledgements-
Supported, in part, by Science Foundation Ireland grant 13/RC/2094 and the COVIGILANT Science Foundation
Ireland grant 20/COV/0133.
We thank Prof. Helen Ward and Dr. Christina Atchison and the research team in the Patient Experience Research
Centre (PERC) of Imperial College London, School of Public Health for permission to use 5 questions from their
survey instrument [17]. Imperial College London, in turn, thanks Prof. Samuel Yeung Shan Wong, Prof. Kin On
Kwok and Ms. Wan In Wei from JC School of Public Health and Primary Care, The Chinese University of Hong
Kong, Hong Kong Special Administrative Region, China for permission to use their survey instrument and
translating it into English (Kwok et al.).
Statement on Participant Consent-
Participants were asked to tick a box on the online survey following the Survey Introduction (see rst page of
Appendix 1) to indicate their consent to participate in our research study. All responses were anonymous.
Conicts of Interest-
The authors declare no conicts of interest.
Authors’contributions-
MOC, LG, and JB conceived of and designed this study, interpreted the data, drafted the manuscript, and revised
the manuscript for important intellectual content. MOC designed and deployed the nal survey instrument. AS
interpreted the data and provide statistical testing expertise and advice, and revised the manuscript for important
intellectual content. DOK, JW, BN, CS aided in interpretation of the data, and revised the manuscript for important
intellectual content. All of the authors reviewed, discussed, and approved the nal manuscript.
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Supplementary Files
This is a list of supplementary les associated with this preprint. Click to download.
Appendix.pdf
... However, based on other surveys in which participants were asked whether they intended to download hypothetical apps, the acceptability of contact tracing apps is higher in other countries. For example, in a recent online survey from Ireland (N>8000) [11], when asked about downloading a contact tracing app that was not yet available, 58% of participants said they would download it and 25% said they probably would [8]. Additionally, in another online survey with almost 6000 participants from 5 countries (ie, the United Kingdom, Germany, Italy, France, and the United States), 75% of participants said they definitely or probably would install a contact tracing app [12]. ...
... With regard to open-ended text responses, 25% of participants in our study who did not download the COVIDSafe app were concerned about privacy. This is lower than the 31% in the smaller Australian study [10] and the 41% in the Irish study [11] who believed privacy was a problem. The differences in these percentages may be due to the free-text responses available in our survey, as the other studies used a list of options for participants' responses. ...
... The differences in these percentages may be due to the free-text responses available in our survey, as the other studies used a list of options for participants' responses. Additionally, compared to the 11.1% of participants in our survey who did not download the app because they distrusted the government, there was more distrust in postpandemic government surveillance with Irish participants (33%) [11] and participants in the cross-country survey (42%) [12]. When considering communication strategies for improving contact tracing app downloads and use, better communication approaches are needed to put the public's concerns about privacy and the government at ease. ...
Article
Background: Timely and effective contact tracing is an essential public health measure for curbing the transmission of COVID-19. App-based contact tracing has the potential to optimize the resources of overstretched public health departments. However, its efficiency is dependent on widespread adoption. Objective: This study aimed to investigate the uptake of the Australian Government’s COVIDSafe app among Australians and examine the reasons why some Australians have not downloaded the app. Methods: An online national survey, with representative quotas for age and gender, was conducted between May 8 and May 11, 2020. Participants were excluded if they were a health care professional or had been tested for COVID-19. Results: Of the 1802 potential participants contacted, 289 (16.0%) were excluded prior to completing the survey, 13 (0.7%) declined, and 1500 (83.2%) participated in the survey. Of the 1500 survey participants, 37.3% (n=560) had downloaded the COVIDSafe app, 18.7% (n=280) intended to do so, 27.7% (n=416) refused to do so, and 16.3% (n=244) were undecided. Equally proportioned reasons for not downloading the app included privacy (165/660, 25.0%) and technical concerns (159/660, 24.1%). Other reasons included the belief that social distancing was sufficient and the app was unnecessary (111/660, 16.8%), distrust in the government (73/660, 11.1%), and other miscellaneous responses (eg, apathy and following the decisions of others) (73/660, 11.1%). In addition, knowledge about COVIDSafe varied among participants, as some were confused about its purpose and capabilities. Conclusions: For the COVIDSafe app to be accepted by the public and used correctly, public health messages need to address the concerns of citizens, specifically privacy, data storage, and technical capabilities. Understanding the specific barriers preventing the uptake of contact tracing apps provides the opportunity to design targeted communication strategies aimed at strengthening public health initiatives, such as downloading and correctly using contact tracing apps.
... In Ireland during 2020, the trade-off between staying safe and making progress in lifting restrictions on social and economic activity was central to perceptions of the country's management of the COVID-19 pandemic (Lunn, et al., 2020d). Further, willingness to protect family and friends is a main reason why people might be in favor of a contact-tracing app (Altmann, et al., 2020;O'Callaghan, et al., 2020). Thus, in one condition we framed the app as a crucial component in the process of lifting restrictions while reducing the chance that users spread the virus to someone vulnerable. ...
... The coordinated effort against COVID-19 involves individuals making sacrifices for the benefit of the larger group (Lunn, et al., 2020a). Indeed, responsibility to the community was another primary reason people gave in favor of a contact-tracing app (Altmann, et al., 2020;O'Callaghan, et al., 2020). Our second condition framed the app using techniques that have been shown to enhance co-operation in such "collective action problems" including articulation of how downloading the app is "best for all" (Zelmer, 2003;Pavitt, 2018;Chaudhuri, 2011). ...
... Another important factor was the timing of this study and the app's launch. We found anxiety about the pandemic to be one of the drivers of likely app uptake, in agreement with another Irish survey (O'Callaghan, et al., 2020). ...
Article
Full-text available
Contact-tracing mobile phone apps can play a role in controlling the spread of COVID-19, but their success hinges on widespread public acceptance, uptake and use, which are difficult for public administrators to foresee. We report on a rapid behavioral pre-test of COVID Tracker, Ireland’s contact-tracing app, prior to its launch. A large sample of participants were randomized to receive different versions of a trial app. They responded to an online survey while downloading and using the app on their phones in real time. Experimental manipulations focused on: (i) the level of privacy assurance provided in the app, (ii) the goal-framing of the purpose of the app and (iii) the structuring of the exposure notification. Almost one in five participants mentioned privacy concerns in relation to their likelihood of downloading the app, but concerns were lower and engagement stronger in a condition that included additional assurances regarding the privacy of users’ data in the app. This finding informed the final version of the app. Overall, our results demonstrate the value and feasibility of pre-testing digital interfaces to improve public administration.
... Since the onset of the COVID-19 pandemic, similar surveys have been conducted worldwide to better understand people's attitudes on the use of COVID-19 related apps [14,27,39,[41][42][43][44][45][46][47][48][49][50][51]. In many of these studies, the impact of gender, social, and demographic factors in different communities have been reported with different results, as presented in Table 7. Differences in the findings of various studies can be explained by differences in the socio-economic, educational, and digital divide in investigated populations. ...
Article
Full-text available
Background and objectives The use of mHealth applications depends on cognitive and social factors of individuals in different nations. This study aimed to identify the factors influencing the use of mHealth applications for both “ contact-tracing ” and “ symptom-monitoring” of COVID-19 among Iranian citizens. Methods A cross-sectional study with an online survey was conducted among Iranian citizens. Correlation calculation and multiple linear regression analysis were performed on the studied variables to find the effective factors. Results A total of 1031 Iranian citizens over the age of 18 participated in this survey. A large percentage of the participants wanted to use the mHealth app to trace contacts of COVID-19 (74.5%) and the mHealth app to identify and monitor COVID-19 symptoms (74.0%). Gender, age, level of education, attitude towards technology, and fear of COVID-19 were among the factors that influenced the intention to use these two apps. The top reasons for using these apps were: “to keep myself and my family safe“, ”to control the spread of the coronavirus in general“, and “to cooperate with healthcare professionals”. The reasons given for not using these two apps were related to the issues of “security and privacy” and “doubt in efficiency and usefulness ”of them. Conclusions The study showed that many participants in this survey were interested in using the COVID-19 apps. Policies, regulations and procedures are needed to protect the privacy of individuals by ensuring data governance. Further investigation with a larger sample is suggested to generalize these results.
... In Ireland, of those surveyed who reported that they would not download the app, the most common reason was privacy [77]. They found concerns that the app host would use personal data for surveillance purposes, rather than for public health, and that surveillance would continue after the pandemic. ...
Article
Unstructured: The global and national response to the COVID-19 pandemic has been inadequate due to a collective lack of preparation and a shortage of available tools for responding to a large-scale pandemic. By applying lessons learned to create better preventative methods and speedier interventions, the harm of a future pandemic may be dramatically reduced. One potential measure is the widespread use of contact tracing apps. While such apps were designed to combat the COVID-19 pandemic, the time scale in which these apps were deployed proved a significant barrier to efficacy. Many companies and governments sprinted to the deployment of contact tracing apps which were not properly vetted for performance, privacy, or security issues. The hasty development of incomplete contact tracing apps undermined public trust and negatively influenced perceptions of application efficacy. As a result, many of these applications had poor voluntary public uptake, which greatly decreased the applications' efficacy. Now, with lessons learned from this pandemic, groups can better design and test applications in preparation for the future. In this review, we outline common strategies employed for contact tracing apps, detail the successes and shortcomings of several prominent apps, and describe lessons learned that may be used to shape effective contact tracing apps for the present and future. Future app designers can keep these lessons in mind to create a version that is suitable for their local culture, especially with regard to local attitudes towards privacy-utility tradeoffs during public health crises.
Article
Background: Contact tracing has been globally adopted in the fight to control the infection rate of COVID-19. Thanks to digital technologies, such as smartphones and wearable devices, contacts of COVID-19 patients can be easily traced and informed about their potential exposure to the virus. To this aim, several mobile applications have been developed. However, there are ever-growing concerns over the working mechanism and performance of these applications. The literature already provides some interesting exploratory studies on the community’s response to the applications by analyzing information from different sources, such as news and users’ reviews of the applications. However, to the best of our knowledge, there is no existing solution that automatically analyzes users’ reviews and extracts the evoked sentiments. We believe such solutions combined with a user-friendly interface can be used as a rapid surveillance tool to monitor how effective an application is and to make immediate changes without going through an intense participatory design method which, although in normal circumstances is optimal, but not optimal in emergency situations where a mobile device needs to be deployed immediately with little to no user input from the beginning for the greater public good. Objective: In this paper, we aim to analyze the efficacy of AI models and Natural Language Processing (NLP) techniques in automatically extracting and classifying the polarity of users’ sentiments by proposing a sentiment analysis framework to automatically analyze users’ reviews on COVID-19 contact tracing mobile applications. We also aim to provide a large-scale annotated benchmark dataset to facilitate future research in the domain. As a proof of concepts, we also develop a potential web application, based on the proposed solutions, with a user-friendly interface to automatically analyze and classify users’ reviews on the COVID-19 contact tracing applications. The proposed framework combined with the interface which is expected to help the community in quickly analyzing users’ perception about such mobile applications and can be used as a rapid surveillance tool to monitor effectiveness of mobile applications and to make immediate changes without going through an intense participatory design method in emergency situations. Methods: We propose a pipeline starting from manual annotation via a crowd-sourcing study and concluding on the development and training of AI models for automatic sentiment analysis of users’ reviews. In detail, we collected and annotated a large- scale dataset of Android and iOS mobile applications users’ reviews for COVID-19 contact tracing. After manually analyzing and annotating users’ reviews, we employed both classical (i.e., Naïve Bayes, SVM, Random Forest) and deep learning (i.e., fastText, and different transformers) methods for classification experiments. This resulted in eight different classification models. Results: We employed eight different methods on three different tasks achieving up to an average F1-Scores 94.8% indicating the feasibility and applicability of automatic sentiment analysis of users’ reviews on the COVID-19 contact tracing applications. Moreover, the crowd-sourcing activity resulted in a large-scale benchmark dataset composed of 34,534 reviews manually annotated from the contract tracing applications of 46 distinct countries. The resulted dataset is also made publicly available for research usage. Conclusions: The existing literature mostly relies on the manual/exploratory analysis of users’ reviews on the application, which is a tedious and time-consuming process. Moreover, in the existing studies, generally, data from fewer applications are analyzed. In this work, we showed that AI and NLP techniques provide good results in analyzing and classifying users’ sentiments’ polarity, and that the automatic sentiment analysis can help in analyzing users’ responses to the application more quickly with a significant accuracy. Moreover, we also provided a large-scale benchmark dataset composed of 34,534 reviews from 47 different applications. We believe the presented analysis, dataset, and the proposed solutions combined with a user-friendly interface can be used as a rapid surveillance tool to analyze and monitor mobile applications deployed in emergency situations leading to rapid changes in the applications without going through an intense participatory design method.
Article
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:
Article
With the expansion of telecommunication and online technologies for the purpose of survey administration, the issue of measurement validity has come to the fore. The proliferation of automated audio services and computer-based survey techniques has been matched by a corresponding denigration of the quality of traditional phone survey data, most notably as an outcome of falling response rates. This trend, combined with the introduction of screening technologies and answering machines, represents a barrier to the proper execution of survey research. Whereas the question was once, “can technology-assisted surveys achieve the same level of validity as traditional phone surveys?”, the question now becomes, “what are the relative advantages and disadvantages of technology-assisted and phone surveys?” Each has its own challenges and opportunities, and this paper begins to explore these. The present study provides further insight into the validity of telephone and Internet survey data, and explores whether or not the robustness of relationships between variables varies by survey mode.Study data were provided by two surveys, the first of which was conducted in a metropolitan area of the Midwestern US, with interviews of 505 adults using a computer-aided telephone-interviewing (CATI) system. The second was a national survey of 2172 respondents conducted over the Internet by a commercial research firm that sends requests to a diverse set of potential respondents, who logged onto the survey site to participate. Results suggest that weighting in an attempt to achieve parametric matching does seem to increase robustness of relationships and, in this age of poor response rates, this seems to demand an increased use of parametric weightings. Implications of study findings for telematic survey practitioners are discussed.
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