Effective Contact Tracing for COVID-19 Using Mobile Phones: An Ethical Analysis of the Mandatory Use of the Aarogya Setu Application in India

Enhancing the implementation and integration of mHealth interventions in resource-limited settings: a scoping review

BACKGROUND

Although mobile health (mHealth) interventions have shown promise in improving health outcomes, most of them rarely translate to scale. Prevailing mHealth studies are largely small-sized, short-term and donor-funded pilot studies with limited evidence on their effectiveness. To facilitate scale-up, several frameworks have been proposed to enhance the generic implementation of health interventions. However, there is a lack of a specific focus on the implementation and integration of mHealth interventions in routine care in low-resource settings. Our scoping review aimed to synthesize and develop a framework that could guide the implementation and integration of mHealth interventions.

METHODS

We searched the PubMed, Google Scholar, and ScienceDirect databases for published theories, models, and frameworks related to the implementation and integration of clinical interventions from 1st January 2000 to 31st December 2023. The data processing was guided by a scoping review methodology proposed by Arksey and O'Malley. Studies were included if they were i) peer-reviewed and published between 2000 and 2023, ii) explicitly described a framework for clinical intervention implementation and integration, or iii) available in full text and published in English. We integrated different domains and constructs from the reviewed frameworks to develop a new framework for implementing and integrating mHealth interventions.

RESULTS

We identified eight eligible papers with eight frameworks composed of 102 implementation domains. None of the identified frameworks were specific to the integration of mHealth interventions in low-resource settings. Two constructs (skill impartation and intervention awareness) related to the training domain, four constructs (technical and logistical support, identifying committed staff, supervision, and redesigning) from the restructuring domain, two constructs (monetary incentives and nonmonetary incentives) from the incentivize domain, two constructs (organizational mandates and government mandates) from the mandate domain and two constructs (collaboration and routine workflows) from the integrate domain. Therefore, a new framework that outlines five main domains-train, restructure, incentivize, mandate, and integrate (TRIMI)-in relation to the integration and implementation of mHealth interventions in low-resource settings emerged.

CONCLUSION

The TRIMI framework presents a realistic and realizable solution for the implementation and integration deficits of mHealth interventions in low-resource settings.

Enhancing the Implementation and Integration of mHealth Interventions in Resource-Limited Settings: A Scoping Review

Background

Although mobile health (mHealth) interventions have shown promise in improving health outcomes, most of them rarely translate to scale. Prevailing mHealth studies are largely small-sized, short-term and donor-funded pilot studies with limited evidence on their effectiveness. To facilitate scale-up, several frameworks have been proposed to enhance the generic implementation of health interventions. However, there is a lack of a specific focus on the implementation and integration of mHealth interventions in routine care in low-resource settings. Our scoping review aimed to synthesize and develop a framework that could guide the implementation and integration of mHealth interventions.

Methods

We searched the PubMed, Google Scholar, and ScienceDirect databases for published theories, models, and frameworks related to the implementation and integration of clinical interventions from 1st January 2000 to 31st December 2023. The data processing was guided by a scoping review methodology proposed by Arksey and O'Malley. Studies were included if they were i) peer-reviewed and published between 2000 and 2023, ii) explicitly described a framework for clinical intervention implementation and integration, or iii) available in full text and published in English. We integrated different domains and constructs from the reviewed frameworks to develop a new framework for implementing and integrating mHealth interventions.

Results

We identified eight eligible papers with eight frameworks composed of 102 implementation domains. None of the identified frameworks were specific to the integration of mHealth interventions in low-resource settings. Two constructs (skill impartation and intervention awareness) related to the training domain, four constructs (technical and logistical support, identifying committed staff, supervision, and redesigning) from the restructuring domain, two constructs (monetary incentives and nonmonetary incentives) from the incentivize domain, two constructs (organizational mandates and government mandates) from the mandate domain and two constructs (collaboration and routine workflows) from the integrate domain. Therefore, a new framework that outlines five main domains-train, restructure, incentivize, mandate, and integrate (TRIMI)-in relation to the integration and implementation of mHealth interventions in low-resource settings emerged.

Conclusion

The TRIMI framework presents a realistic and realizable solution for the implementation and integration deficits of mHealth interventions in low-resource settings.

Greenway of Digital Health Technology During COVID-19 Crisis: Bibliometric Analysis, Challenges, and Future Perspective

Digital health has transformed the healthcare landscape by leveraging technology to improve patient outcomes and access to medical services. The COVID-19 pandemic has highlighted the urgent need for digital healthcare solutions that can mitigate the impact of the outbreak while ensuring patient safety. In this chapter, we delve into how digital health technologies such as telemedicine, mobile apps, and wearable devices can provide personalized care, reduce healthcare provider burden, and lower healthcare costs. We also explore the creation of a greenway of digital healthcare that safeguards patient confidentiality, enables efficient communication, and ensures cost-effective payment systems. This chapter showcases the potential of digital health to revolutionize healthcare delivery while ensuring patient well-being and medical staff satisfaction.

["Sending a signal of solidarity via bluetooth?"-A medical ethical analysis of the public debate on the Corona-Warn-App]

Definition of the problem

In the public debate in Germany on the Corona-Warn-App, the concept of solidarity is a prominent, but contested normative reference point. Thus, different uses of the concept with heterogeneous assumptions, normative implications and practical consequences stand next to each other and require medical ethical investigation. Against this backdrop, this contribution aims firstly to illustrate the spectrum of understandings of the concept of solidarity in the public debate on the Corona-Warn-App. Secondly, it elaborates the preconditions and normative implications of these uses and evaluates them from an ethical perspective.

Arguments

Starting with an introduction of the Corona-Warn-App and a general definition of the concept of solidarity, I present four examples for different uses of the concept of solidarity from the public discourse on the Corona-Warn-App that vary regarding the underlying identification, the group of solidarity, the solidarity contribution and the normative goal. They highlight the need for further ethical standards in order to assess their legitimacy. Hence, I use four normative criteria of a context-sensitive, morally substantial conception of solidarity (openness, malleable inclusivity, adequacy of the contribution, normative dependence) to ethically evaluate the solidarity recourses presented.

Conclusion

Critical remarks can be formulated for all presented notions of solidarity. On the one hand, the potentials and limitations of solidarity recourses in public debates become apparent. On the other, criteria can be derived for a solidarity-promoting use of the Corona-Warn-App.

Innovation for infection prevention and control-revisiting Pasteur's vision

Louis Pasteur has long been heralded as one of the fathers of microbiology and immunology. Less known is Pasteur's vision on infection prevention and control (IPC) that drove current infection control, public health, and much of modern medicine and surgery. In this Review, we revisited Pasteur's pioneering works to assess progress and challenges in the process and technological innovation of IPC. We focused on Pasteur's far-sighted conceptualisation of the hospital as a reservoir of microorganisms and amplifier of transmission, aseptic technique in surgery, public health education, interdisciplinary working, and the protection of health services and patients. Examples from across the globe help inform future thinking for IPC innovation, adoption, scale up and sustained use.

Tracing app technology: an ethical review in the COVID-19 era and directions for post-COVID-19

We conducted a systematic literature review on the ethical considerations of the use of contact tracing app technology, which was extensively implemented during the COVID-19 pandemic. The rapid and extensive use of this technology during the COVID-19 pandemic, while benefiting the public well-being by providing information about people's mobility and movements to control the spread of the virus, raised several ethical concerns for the post-COVID-19 era. To investigate these concerns for the post-pandemic situation and provide direction for future events, we analyzed the current ethical frameworks, research, and case studies about the ethical usage of tracing app technology. The results suggest there are seven essential ethical considerations-privacy, security, acceptability, government surveillance, transparency, justice, and voluntariness-in the ethical use of contact tracing technology. In this paper, we explain and discuss these considerations and how they are needed for the ethical usage of this technology. The findings also highlight the importance of developing integrated guidelines and frameworks for implementation of such technology in the post- COVID-19 world.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10676-022-09659-6.

Exploring the scope and utility of digital proximity tracing in the effective containment of COVID-19 infection: A narrative review

The ongoing coronavirus disease-2019 (COVID-19) pandemic can be acknowledged as one of the most significant public health emergencies the world has encountered in the last few decades. The purpose of the current review is to understand the significance of contact tracing and explore the pros and cons of digital contact tracing in ensuring better containment of the COVID-19 outbreaks. A widespread search of published articles pertaining to the topic was done in the PubMed search engine and a total of 46 articles matching the objectives of the present review were identified. However, four articles were discarded because of the non-availability of the free full text, and thus 42 research papers were finally included. Digital contact tracing bridges the gap wherein we aim to expedite the process of contact tracing to identify the potential contacts of the confirmed cases. These applications are designed in such a way that they send a notification on the smartphone of a person, once the user is exposed to one or more confirmed cases of COVID-19. To conclude, in the battle against the COVID-19 infection, the international welfare agencies and national policy makers have been looking forward to the employment of digital technologies to support the ongoing public health measures for contact tracing. The approach of digital contact/proximity tracing should be considered as a supplement to conventional manual tracing. The need of the hour is to take specific measures to improve the inherent design of these apps, their implementation and demonstration of their effectiveness, which in turn will play a part in enhancing their acceptance and usability among the general population.

Delineating privacy aspects of COVID tracing applications embedded with proximity measurement technologies & digital technologies

As the COVID-19 pandemic expanded over the globe, governments implemented a series of technological measures to prevent the disease's spread. The development of the COVID Tracing Application (CTA) was one of these measures. In this study, we employed bibliometric and topic-based content analysis to determine the most significant entities and research topics. Additionally, we identified significant privacy concerns posed by CTAs, which gather, store, and analyze data in partnership with large technology corporations using proximity measurement technologies, artificial intelligence, and blockchain. We examined a series of key privacy threats identified in our study. These privacy risks include anti-democratic and discriminatory behaviors, politicization of care, derogation of human rights, techno governance, citizen distrust and refusal to adopt, citizen surveillance, and mandatory legislation of the apps' installation. Finally, sixteen research gaps were identified. Then, based on the identified theoretical gaps, we recommended fourteen prospective study strands. Theoretically, this study contributes to the growing body of knowledge about the privacy of mobile health applications that are embedded with cutting-edge technologies and are employed during global pandemics.

Six sigma DMAIC approach based mobile application for statistical analysis of COVID-19 data

Purpose

Coronavirus disease 2019 is one of the novel diseases formed by a dreadful virus called Severe Acute Respiratory Syndrome Coronavirus 2. Various countries are affected by this viral disease, and many countries declare a lockdown with several rules and conditions. To prevent this rapid viral transmission, various researchers have introduced different mobile applications. This paper aims to study issues like viral transmission, mortality rates, vaccination rates, etc. and also provides suitable solutions based on the statistical analysis with the assistance of the Six-Sigma Define-Measure-Analyse-Improve-Control (DMAIC) concept.

Design/methodology/approach

Statistical analysis is done for different countries, and the required solutions are provided by using the DMAIC procedure. This application has the ability to represent the current risk status of the user and notify them to secure themselves.

Findings

The proposed work suggests the Aarogya Setu application to prevent large viral transmission by affording many preventive measures. This application also issues the current risk status of each individual user. Hence, it gives improved results in avoiding high viral transmission.

Originality/value

The proposed six-sigma DMAIC concept also affords the control measures to prevent viral transmission. Hence, the suggested application has the highest chance of avoiding the rapid viral transmission.

The application framework of big data technology during the COVID-19 pandemic in China

Big data has been reported widely to facilitate epidemic prevention and control in health care during the coronavirus disease 2019 (COVID-19) pandemic. However, there is still a lack of practical experience in applying it to hospital prevention and control. This study is devoted to the practical experience of design and implementation as well as the preliminary results of an innovative big data-driven COVID-19 risk personnel screening management system in a hospital. Our screening system integrates data sources in four dimensions, which includes Health Quick Response (QR) code, abroad travelling history, transportation close contact personnel and key surveillance personnel. Its screening targets cover all patients, care partner and staff who come to the hospital. As of November 2021, nearly 690 000 people and 5.79 million person-time had used automated COVID-19 risk screening and monitoring. A total of 10 376 person-time (0.18%) with abnormal QR code were identified, 242 person-time with abroad travelling history were identified, 925 person-time were marked based on the data of key surveillance personnel, no transportation history personnel been reported and no COVID-19 nosocomial infection occurred in the hospital. Through the application of this system, the hospital's expenditure on manpower and material resources for epidemic prevention and control has also been significantly reduced. Collectively, this study has proved to be an effective and efficient model for the use of digital health technology in response to the COVID-19 pandemic. Based on the data from multiple sources, this system has an irreplaceable role in identifying close contacts or suspicious person, and can significantly reduce the social burden caused by COVID-19, especially the human resources and economic costs of hospital prevention and control. It may provide guidance for clinical epidemic prevention and control in hospitals, as well as for future public health emergencies.

COVID Alert: Factors Influencing the Adoption of Exposure Notification Apps Among Canadian Residents

The continued emergence of new variants of COVID-19 such as the Delta and Omicron variants, which can cause breakthrough infections, indicates that contact tracing and exposure notification apps (ENAs) will continue to be useful for the long haul. However, there is limited work to uncover the strongest factors that influence their adoption. Using Canada's "COVID Alert" as a case study, we conducted an empirical, technology-acceptance study to investigate the key factors that account for users' intention to use ENAs and the moderating effect of important human and design factors. Our path model analysis shows that four factors significantly influence the adoption of COVID Alert among Canadian residents: perceived risk, perceived usefulness, perceived trust, and perceived compatibility. The overall model explains over 60% of intention to use, with type of design, use case (functional interface), and adoption status moderating the strength of the relationships between the four factors and intention to use. We discuss these findings and make recommendations for the design of future ENAs.

National approaches for citizen data management in response to COVID-19: An overview and implications of contact tracing apps in 21 countries

The COVID-19 pandemic brings the topic of citizen data management (CDAMA) into the public eye. This study is one of the first attempts to analyze the national approaches for CDAMA applied by governments of different countries and continents in public sectors. The study first conducts a systematic overview of the representative contact tracing apps in 21 countries of four continents, collecting information of the four aspects of the CDAMA system. It then summarizes and analyzes the various governments’ approaches to the CDAMA system applied by different countries and continents based on the app overview. We found that governments’ priority between national safety (i.e., public health in this study) and citizen privacy is different in terms of their national approaches for CDAMA. For example, governments of Asian countries are more intrusive and hold a stricter attitude in their national CDAMA approach than countries elsewhere. Our study has contributions both theoretically and practically. Theoretically, it fills the literature gap about data management by adding the data management in governments; practically, the study provides the background information as well as implications for future debate and discussion on governments’ data management system and citizen data use.

Designing Better Exposure Notification Apps: The Role of Persuasive Design

BACKGROUND

Digital contact tracing apps have been deployed worldwide to limit the spread of COVID-19 during this pandemic and to facilitate the lifting of public health restrictions. However, due to privacy-, trust-, and design-related issues, the apps are yet to be widely adopted. This calls for an intervention to enable a critical mass of users to adopt them.

OBJECTIVE

The aim of this paper is to provide guidelines to design contact tracing apps as persuasive technologies to make them more appealing and effective.

METHODS

We identified the limitations of the current contact tracing apps on the market using the Government of Canada's official exposure notification app (COVID Alert) as a case study. Particularly, we identified three interfaces in the COVID Alert app where the design can be improved. The interfaces include the no exposure status interface, exposure interface, and diagnosis report interface. We propose persuasive technology design guidelines to make them more motivational and effective in eliciting the desired behavior change.

RESULTS

Apart from trust and privacy concerns, we identified the minimalist and nonmotivational design of exposure notification apps as the key design-related factors that contribute to the current low uptake. We proposed persuasive strategies such as self-monitoring of daily contacts and exposure time to make the no exposure and exposure interfaces visually appealing and motivational. Moreover, we proposed social learning, praise, and reward to increase the diagnosis report interface's effectiveness.

CONCLUSIONS

We demonstrated that exposure notification apps can be designed as persuasive technologies by incorporating key persuasive features, which have the potential to improve uptake, use, COVID-19 diagnosis reporting, and compliance with social distancing guidelines.

Implementing Public Health Strategies-The Need for Educational Initiatives: A Systematic Review

In the absence of a specific treatment or vaccines, public health strategies are the main measures to use in the initial stages of a pandemic to allow surveillance of infectious diseases. During the ongoing global pandemic of coronavirus disease 2019 (COVID-19), several countries initiated various public health strategies, such as contact tracing and quarantine. The present study aims to conduct a systematic literature review to identify the presence of educational initiatives that promote the implementation of public health strategies before public health emergencies, with a special focus on contact tracing applications. Using Science Direct, PubMed, Scopus, and Gothenburg University search engines, all published scientific articles were included, while conference, reports, and non-scientific papers were excluded. The outcomes of the reviewed studies indicate that the effective implementation of public health strategies depends on the peoples' willingness to participate and collaborate with local authorities. Several factors may influence such willingness, of which ethical, psychological, and practical factors seem to be the most important and frequently discussed. Moreover, individual willingness and readiness of a community may also vary based on the acquired level of knowledge about the incident and its cause and available management options. Educational initiatives, proper communication, and timely information at the community level were found to be the necessary steps to counteract misinformation and to promote a successful implementation of public health strategies and attenuate the effects of a pandemic. The systematic review conducted as a part of this study would benefit the relevant stakeholders and policy makers and assist with effective designing and implementation.

A Survey on Security and Privacy Issues in Contact Tracing Application of Covid-19

In response to the coronavirus (COVID-19) pandemic, Government and public health authorities around the world are developing contact tracing apps as a way to trace and slow the unfold of the virus. There is major divergence among nations, however, between a "privacy-first" approach that protects citizens' information at the price of very restricted access for public health authorities and a "data-first" approach that stores massive amounts of knowledge that, whereas of immeasurable price to epidemiologists. Contact tracing apps work by gathering information from people who have tested positive for the virus and so locating and notifying individuals with whom those people are in shut contact, oftentimes by use of GPS, Bluetooth, or wireless technology. All of the user's information is employed and picked up, the study found that users' information would be created anonymous, encrypted, secured, and can be transmitted on-line and stored solely in an aggregated format. Contact tracing apps use either a centralized or a decentralized approach to work the user's information. Apps that use a centralized approach have high privacy risks. In this paper, the researcher's contributions related to the security and privacy of Contact tracing apps have been discussed and, later research gaps have been identified with proposed solutions.