Technology, Privacy, and User Opinions of COVID-19 Mobile Apps for Contact Tracing: Systematic Search and Content Analysis

Screening and early detection of communicable diseases on board cruise ships: An assessment of passengers' preferences on technical solutions

BACKGROUND

Implementing technological solutions to screen for and detect early the most prevalent communicable diseases on cruise ships is contingent on, among others, willingness of passengers to accept use of such solutions.

METHOD

We surveyed passenger preferences to record their willingness to accept technological solutions for screening and early detection of communicable diseases on cruise ships. Self-reported sociodemographic characteristics, use of technology and acceptance of solutions were recorded anonymously in paper format. Multiple logistic regression analyses investigated the association of demographic and other characteristics with willingness and barriers/concerns of passengers to endorse proposed solutions.

RESULTS

Of a total of 1344 passengers on two successive cruises on board CELESTYAL OLYMPIA, 336 (1 every 4) participated in the survey. The vast majority of passengers (92.3 %, n = 310) agreed with at least one solution. Passengers showed lower levels of acceptance for more personalized solutions, such as use of wearable devices (45.5 %) and monitoring with cameras (64.0 %), whereas they were more receptive to less personally invasive solutions, such as integration of cabins with air purifiers (89.6 %) and air quality sensors (80.4 %). Age, self-employment status, educational level, and fear of contacting a communicable disease were significantly correlated with passengers' willingness to adopt proposed solutions.

CONCLUSIONS

To successfully integrate screening and early detection technological solutions in cruise ships, it is imperative that targeted awareness and education interventions are implemented on passengers to strengthen understanding and acceptance of such solutions and assuage concerns around monitoring and handling of personal health data.

"I am not a Robot, I am Asexual": A Qualitative Critique of Allonormative Discourses of Ace and Aro Folks as Robots, Aliens, Monsters

Despite exploring other queer topics, communication scholars and rhetoricians are lacking in offering academic inquiries involving asexuality. We engaged in a critical thematic analysis of posts and comments posted from asexual and/or aromantic folks on the online communities of Reddit and AVEN, the Asexuality Visibility & Education Network. The analysis focused on three cultural tropes prominently used when describing asexual and aromantic folks, namely robots, aliens, and monsters. Our discussion centers asexual and aromantic voices and invites communication and rhetorical scholars to take steps in combating the allonormativity of our fields by centering the voices and experiences of intersectional aces and/or aros in their own research. We conclude with a call for an asexual and aromantic communication studies.

Evaluating the Added Value of Digital Contact Tracing Support Tools for Citizens: Framework Development

BACKGROUND

The COVID-19 pandemic revealed that with high infection rates, health services conducting contact tracing (CT) could become overburdened, leading to limited or incomplete CT. Digital CT support (DCTS) tools are designed to mimic traditional CT, by transferring a part of or all the tasks of CT into the hands of citizens. Besides saving time for health services, these tools may help to increase the number of contacts retrieved during the contact identification process, quantity and quality of contact details, and speed of the contact notification process. The added value of DCTS tools for CT is currently unknown.

OBJECTIVE

To help determine whether DCTS tools could improve the effectiveness of CT, this study aims to develop a framework for the comprehensive assessment of these tools.

METHODS

A framework containing evaluation topics, research questions, accompanying study designs, and methods was developed based on consultations with CT experts from municipal public health services and national public health authorities, complemented with scientific literature.

RESULTS

These efforts resulted in a framework aiming to assist with the assessment of the following aspects of CT: speed; comprehensiveness; effectiveness with regard to contact notification; positive case detection; potential workload reduction of public health professionals; demographics related to adoption and reach; and user experiences of public health professionals, index cases, and contacts.

CONCLUSIONS

This framework provides guidance for researchers and policy makers in designing their own evaluation studies, the findings of which can help determine how and the extent to which DCTS tools should be implemented as a CT strategy for future infectious disease outbreaks.

The Implications of Using Digital Technologies in the Management of COVID-19: Comparative Study of Japan and South Korea

BACKGROUND

Technology can assist in providing effective infectious disease management, but it can also become a source of social injustice and inequality. To control the rapidly increasing SARS-CoV-2 infections and promote effective vaccine administration, both South Korea and Japan have been using several technology-based systems and mobile apps. However, their different approaches to technology use have yielded contrasting social implications.

OBJECTIVE

Through comparative studies of the use of digital technologies for pandemic management and its social implications in Japan and South Korea, this study aimed to discuss whether the active and optimal use of technology for pandemic management can occur without subverting or compromising important social values, such as privacy and equality.

METHODS

This study compared the social implications of Japan's and South Korea's contrasting approaches to technology implementation for COVID-19 pandemic management in early 2022.

RESULTS

Digital technologies have been actively and comprehensively used in South Korea, enabling effective COVID-19 management, but have raised serious concerns about privacy and social equality. In Japan, technologies have been more carefully implemented, thereby not causing similar social concerns, but their effectiveness in supporting COVID-19 regulations has been criticized.

CONCLUSIONS

Potential social implications such as equality concerns, the balance between public interest and individual rights, and legal implications must be carefully assessed in conjunction with effective and optimal infectious disease control to achieve sustainable use of digital health technologies for infectious disease management in the future.

A Survey on harnessing the Applications of Mobile Computing in Healthcare during the COVID-19 Pandemic: Challenges and Solutions

The COVID-19 pandemic ravaged almost every walk of life but it triggered many challenges for the healthcare system, globally. Different cutting-edge technologies such as Internet of things (IoT), machine learning, Virtual Reality (VR), Big data, Blockchain etc. have been adopted to cope with this menace. In this regard, various surveys have been conducted to highlight the importance of these technologies. However, among these technologies, the role of mobile computing is of paramount importance which is not found in the existing literature. Hence, this survey in mainly targeted to highlight the significant role of mobile computing in alleviating the impacts of COVID-19 in healthcare sector. The major applications of mobile computing such as software-based solutions, hardware-based solutions and wireless communication-based support for diagnosis, prevention, self-symptom reporting, contact tracing, social distancing, telemedicine and treatment related to coronavirus are discussed in detailed and comprehensive fashion. A state-of-the-art work is presented to identify the challenges along with possible solutions in adoption of mobile computing with respect to COVID-19 pandemic. Hopefully, this research will help the researchers, policymakers and healthcare professionals to understand the current research gaps and future research directions in this domain. To the best level of our knowledge, this is the first survey of its type to address the COVID-19 pandemic by exploring the holistic contribution of mobile computing technologies in healthcare area.

Factors associated with acceptance of a digital contact tracing application for COVID-19 in the Japanese working-age population

The working-age population is at the epicenter of coronavirus disease 2019 (COVID-19) infections. Therefore, it is important to increase the acceptance of digital contact tracing apps in this population. Contact-Confirming Application (COCOA) is the only digital contact tracing app in Japan. This study aimed to determine factors associated with acceptance of the COCOA for COVID-19 in the Japanese working-age population. A cross-sectional study was performed for 27,036 full-time workers registered with an internet survey company during December 2020 in Japan. Factors associated with COCOA adoption were evaluated by multivariate logistic regression analysis. The rate of downloading the COCOA was 25.1%. The COCOA was more likely to be accepted by people with married status, university graduation or above, higher income, and occupations involving desk work. Fear of COVID-19 transmission, wearing a mask, using hand disinfection, willingness to be vaccinated against COVID-19, and presence of an acquaintance infected with COVID-19 were also associated with a greater likelihood of adopting the app. The rate of downloading the COCOA in Japan was not very high. The present findings have important implications for widespread adoption of digital contact tracing apps in working-age populations in Japan and elsewhere.

Country- and app-level factors affecting the adoption and evaluation of COVID-19 mobile apps

BACKGROUND

Countries across the globe have released many COVID-19 mobile apps. However, there is a lack of systematic empirical investigation into the factors affecting the adoption and evaluation of COVID-related apps. This study explores what factors at the country level and the app levels would influence the adoption and evaluation of COVID-19 apps.

METHODS

We collected data on 267 COVID-19 apps in App Store and Google Play. The number of installs, ratings, reviews and rating scores were used as indicators of adoption and evaluation. Country-level predictors include the number of infected cases and the political system (i.e., democratic vs. non-democratic). App-level predictors include developer (i.e., government vs. non-government) and functions. Four app functions were coded for analysis: providing health information, contact tracing, home monitoring, and consultation. Negative binomial regression and OLS (Ordinary Least Square) regression were used to analyze the data.

RESULTS

Our analyses show that apps developed by countries with more infected cases (B = 0.079, CI (Confidence Interval) = 0.000, 0.158; P = .049) and by non-governmental institutions (B=-0.369, CI=-0.653, -0.083; P = .01) received more positive rating scores. Apps with home monitoring function received lower rating scores (B=-0.550, CI=-0.971, -0.129; P = .01). Regarding adoption, apps developed by governments were more likely to be installed (IRR (Incident Rate Ratio) = 8.156, CI = 3.389, 19.626; P < .001), to be rated (IRR = 26.036, CI = 7.331, 92.468; P < .001), and to receive user comments (IRR = 12.080, CI = 3.954, 37.568; p < .001). Apps with functions of contact tracing or consultation were more likely to be installed (IRR = 4.533, CI = 2.072, 9.918; p < .001; IRR = 4.885, CI = 1.970, 12.111; p < .001), to be rated (IRR = 11.634, CI = 3.486, 38.827; p < .001; IRR = 17.194, CI = 5.309, 55.680; p < .001), and to receive user comments (IRR = 5.688, CI = 2.052, 5.770; p < .001; IRR = 16.718, CI = 5.363, 52.113; p < .001). Apps with home monitoring functions were less likely to be rated (IRR = 0.206, CI = 0.047, 0.896; P = .04) but more likely to receive user comments (IRR = 3.874, CI = 1.044, 14.349; P = .04). Further analysis shows that apps developed in democratic countries (OR (Odd Ratio) = 3.650, CI = 1.238, 10.758; P = .02) or by governments (OR = 7.987, CI = 4.106, 15.534, P < .001) were more likely to include the function of contact tracing.

CONCLUSION

This study systematically investigates factors affecting the adoption and evaluation of COVID-19 apps. Evidence shows that government-developed apps and the inclusion of contact tracing and consultation app functions strongly predict app adoption.

Insights from Review and Content Analysis of Current COVID-19 Mobile Apps and Recommendations for Future Pandemics

A number of mobile health apps related to coronavirus infectious disease 2019 (COVID-19) have been developed, but research into app content analytics for effective surveillance and management is still in its preliminary stages. The present study aimed to identify the purpose and functions of the currently available COVID-19 apps using content analysis. The secondary aim was to propose directions for the future development of apps that aid infectious disease surveillance and control with a focus on enhancing the app content and quality. Prior to conducting an app search in the App Store and the Google Play Store, we reviewed previous studies on COVID-19 apps found in Google Scholar and PubMed to examine the main purposes of the apps. Using the five selected keywords based on the review, we searched the two app stores to retrieve eligible COVID-19 apps including those already addressed in the reviewed literature. We conducted descriptive and content analyses of the selected apps. We classified the purpose types of the COVID-19 apps into the following five categories: Information provision, tracking, monitoring, mental health management, and engagement. We identified 890 apps from the review articles and the app stores: 47 apps met the selection criteria and were included in the content analysis. Among the selected apps, iOS apps outnumbered Android apps, 27 apps were government-developed, and most of the apps were created in the United States. The most common function for the iOS apps (63.6%) and Android apps (62.5%) was to provide COVID-19-related knowledge. The most common function among the tracking apps was to notify users of contact with infected people by the iOS apps (40.9%) and Android apps (37.5%). About 29.5% of the iOS apps and 25.0% of the Android apps were used to record symptoms and self-diagnose. Significantly fewer apps targeted mental health management and engagement. Six iOS apps (6/44, 13.6%) and four Android apps (4/24, 16.7%) provided behavioral guidelines about the pandemic. Two iOS apps (2/44, 4.5%) and two Android apps (2/24, 8.3%) featured communication functions. The present content analysis revealed that most of the apps provided unilateral information and contact tracing or location tracking. Several apps malfunctioned. Future research and development of COVID-19 apps or apps for other emerging infectious diseases should address the quality and functional improvements, which should begin with continuous monitoring and actions to mitigate any technical errors.

Descriptive Analysis of Mobile Apps for Management of COVID-19 in Spain and Development of an Innovate App in that field

To address the current pandemic, multiple studies have focused on the development of new mHealth apps to help in curbing the number of infections, these applications aim to accelerate the identification and self-isolation of people exposed to SARS-CoV-2, the coronavirus known to cause COVID-19, by being in close contact with infected individuals. The main objectives of this paper are: (1) Analyze the current status of COVID-19 apps available on the main virtual stores: Google Play Store and App Store for Spain, and (2) Propose a novel mobile application that allows interaction and doctor-patient follow-up without the need for real-time consultations (face-to-face or telephone). In this research, a search for eHealth and telemedicine apps related to Covid-19 was performed in the main online stores: Google Play Store and App Store, until May 2021. Keywords were entered into the search engines of the online stores and relevant apps were selected for study using a PRISMA methodology. For the design and implementation of the proposed app named COVINFO, the main weaknesses of the apps studied were taken into account in order to propose a novel and useful app for healthcare systems. The search yielded a total of 50 apps, of which 24 were relevant to this study, of which 23 are free and 54% are available for Android and iOS operating systems (OS). The proposed app has been developed for mobile devices with Android OS being compatible with Android 4.4 and higher. This app enables doctor-patient interaction and constant monitoring of the patient's progress without the need for calls, chats or face-to-face consultation in real time. This work addresses design and development of an application for the transmission of the user's symptoms to his regular doctor, based on the fact that only 16.6% of existing applications have this functionality. The COVINFO app offers a novel service: asynchronous doctor-patient communication, as well as constant monitoring of the patient's condition and evolution. This app makes it possible to better manage the time of healthcare personnel and avoid overcrowding in hospitals, with the aim of preventing the collapse of healthcare systems and the spread of the coronavirus.

Public views on the Covid-19 immunity certificate: A scoping review

INTRODUCTION

Already in its first implementation, the introduction of the Covid-19 immunity certificate has generated some debate among the public. This debate might be a hindrance to the effective realization of this policy. This study aimed to systematically review published research evaluating public feeling of the Covid-19 immunity certificate policy measure and to find which factors might influence its acceptance.

METHODS

We followed the scoping review methods manual by the Joanna Briggs Institute. We included studies with no time limits that presented novel data, and no exclusions have been made based on study design. We excluded articles that presented just expert opinions.

RESULTS

We found and reviewed 17 articles. The included studies were conducted in two main countries (the United Kingdom and Switzerland), with the rest from Israel, Italy, Spain, Germany, Australia, Taiwan and China. Both qualitative and quantitative studies were included, and nonrepresentative samples were mostly used to explore the public feeling about the Covid-19 immunity certification. The included studies showed that public views on immunity certification are quite contradictory and influenced by age, gender, ethnicity, political orientation and attitudes towards Covid-19 vaccination. The topic more often addressed by the included studies was the public's views on the positive and negative implications of the Covid-19 immunity certificate in terms of ethical, legal and behavioural consequences of this measure.

CONCLUSION

The varying acceptance rates are notable and may partly be linked to differences in demographics, Covid-19 concerns and ideological beliefs, as seen in other health-related tracking policies. Moreover, dominant factors behind the (un)success of this policy are complex and entangled with the cultural and political dimensions rather than being just technical. For this reason, it is important to expand psychosocial research to better understand the concerns behind health certifications and allow planning of culturally based and ethically sound suitable strategies. This would be very relevant to increasing public approval and compliance with this public health measure.

PATIENT OR PUBLIC CONTRIBUTION

This does not apply to our work as it was a review paper.

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.

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

Background

COVID-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.

Objective

This 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.

Methods

We 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.

Results

We 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.

Conclusions

Many 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.

Exposure Detection Applications Acceptance: The Case of COVID-19

The pandemic's context is rife with numerous dangerous threats and high fear levels, influencing human decision-making. Such characteristics are identified by investigating the acceptance of exposure detection apps from the technology acceptance model (TAM) perspective. This study purposed a model to investigate protection technology acceptance, specifically exposure detection apps in the context of COVID-19. Quantitative study approach and a cross-section design targeted 586 participants from Saudi Arabia. As the study model is complex, the study hypotheses were analysed using the structural equation modelling-partial least squares (SEM-PLS3) approach. The findings support the entire model hypothesis except the link between social media awareness and exposure detection apps' intention. Mediation of COVID-19 anxiety and influence was confirmed as well. The current paper contributes to the technologies acceptance domain by developing a context-driven model comprising the major pandemic characteristics that lead to various patterns of technology acceptance. This study also fills the literature gap regarding mediating effects of social influence and COVID-19 anxiety in the relationship between trust in government and exposure detection apps implementation, and between COVID-19 anxiety and exposure detection apps implementation, respectively. The results may assist government agencies, health policymakers, and health organisations in the wide world and specifically Saudi Arabia, in their attempts to contain the COVID-19 pandemic spread.

Effectiveness, Policy, and User Acceptance of Covid-19 Contact Tracing Applications (CTAs) During the Post-COVID-19 Pandemic: An Experience and Comparative Study (Preprint)

Background

Objective

Methods

Results

Conclusions

What Went Wrong with the IMMUNI Contact-Tracing App in Italy? A Cross-Sectional Survey on the Attitudes and Experiences among Healthcare University Students

The adoption of digital contact-tracing apps to limit the spread of SARS-CoV-2 has been sup-optimal, but studies that clearly identify factors associated with the app uptake are still limited. In April 2021, we administered a questionnaire to healthcare university students to investigate their attitudes towards and experiences of the IMMUNI app. A multivariable logistic regression model was built to identify app download predictors. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. We surveyed 247 students. Most respondents (65.6%) had not downloaded IMMUNI, reporting as the main reason the perceived app uselessness (32.7%). In the multivariable analysis, being advised to use the app (aOR: 3.21, 95%CI: 1.80-5.73), greater fear of infecting others (aOR: 1.50, 95%CI: 1.01-2.23), and greater trust in the institutional response to the emergency (aOR: 1.33, 95%CI: 1.00-1.76) were positively associated with the outcome, whereas greater belief in the "lab-leak theory" of COVID-19 was a negative predictor (aOR: 0.75, 95%CI: 0.60-0.93). Major technical issues were reported by app users. Targeted strategies aimed at improving awareness of digital health applications should be devised. Furthermore, institutions should invest in the development of these technologies, to minimize technical issues and make them accessible to the entire population.

Evaluation of the Patient Experience with the Mawid App during the COVID-19 Pandemic in Al Hassa, Saudi Arabia

(1) Introduction: The objective of this study was to evaluate the patient experience with the Mawid application during the COVID-19 pandemic in Al Hassa, Saudi Arabia. (2) Methodology: A quantitative cross-sectional survey was designed to evaluate the patient experience with the Mawid app during the COVID-19 pandemic in Al Hassa, Saudi Arabia. A total of 146 respondents completed the questionnaire. (3) Results: More than half of the participants (65.8%) opined that application was easy to use. Furthermore, 65.1% of the participants considered it to be very easy and easy to search for the required information; and 63.7% of the respondents reflected that it was easy to book an appointment. There was a statistically significant difference between the ease of searching for the required information (p-value = 0.006); the ease of undoing an unwanted move and gender (p-value = 0.049); the ease of searching for the required information and educational level (p-value = 0.048); the ease of booking an appointment and educational level (p = 0.049); and the ease of searching for the required information and the labor sector of the respondents (p value= 0.049) among the genders. No significant differences were identified among the age groups. (4) Conclusions: Overall, most participants suggested that the Mawid app was easy to use and had a potentially useful set of features to help mitigate and manage the COVID-19 pandemic in Al Hassa, Saudi Arabia.

Strengthening the Trialability for the Intention to Use of mHealth Apps Amidst Pandemic: A Cross-Sectional Study

Recent advancements in mHealth apps and services have played a vital role in strengthening healthcare services and enabling their accessibility to marginalized people. With the alarming rise in COVID-19 infection rates around the world, there appears to be an urgent call to modernize traditional medical practices to combat the pandemic. This study aims to investigate the key factors influencing the trialability of mHealth apps/services and behavioral intention to adopt mobile health applications. The study also examines the moderating effects of self-discipline motivation, knowledge, and attitude on the relationship between trialability and behavioral intention to use. The deductive reasoning approach was followed in a positivism paradigm. The study used convenience sampling and collected responses from 280 Generation Y participants in Bangladesh. Partial least square-based structural equation modeling was employed. The results revealed that relative advantage (β = 0.229, p < 0.05), compatibility (β = 0.232, p < 0.05), complexity (β = −0.411, p < 0.05), and observability (β = 0.235, p < 0.05) of mHealth apps influence the trialability of mHealth apps and services among users. Trialability compatibility (β = 0.425, p < 0.05) of mHealth was positively related to the behavioral intention to use these mobile apps. The study found no moderating effects of attitude (β = 0.043, p > 0.05) or self-discipline motivation (β = −0.007, p > 0.05) on the hypothesized relationships. The empirical findings of this study may facilitate the development, design process, and implementation of mHealth applications with improved features that can lead to high user acceptance among Generation Y during future health crises.

Covidseeker: A Geospatial Temporal Surveillance Tool

Introduction: Geospatial temporal data derived from smartphones traditionally used for purposes of navigation may offer valuable information for public health surveillance and locational hot spotting. Our objective was to develop a web-based application, called Covidseeker, that captures continuous fine-grained geospatial temporal data from smartphones and leverages these data to study transmission patterns of COVID-19. Methods: This report describes the development of Covidseeker and the process by which it utilizes geospatial temporal data from smartphones and processes it into a usable format to study geospatial temporal patterns of COVID-19. We provide an overview of the design process, the principles, the software architecture, and the dashboard of the Covidseeker application and consider key challenges and strategic uses of capturing geospatial temporal data and the potential for future applications in outbreak surveillance. Results: A resource such as Covidseeker can support situational awareness by providing information about the location and timing of transmission of diseases such as COVID-19. Geospatial temporal data housed in smartphones hold tremendous potential to capture more depth about where and when transmission occurs and the patterns of human mobility that lead to increases in risk of COVID-19. Conclusion: An enormous and highly rich source of geospatial temporal information about human mobility can be used to provide highly localized discrete information that is difficult to capture by traditional sources. The architecture of Covidseeker can be applied to help track COVID-19 and should be integrated with traditional disease surveillance practices.

Joint analysis of the intention to vaccinate and to use contact tracing app during the COVID-19 pandemic

Pharmacological and non-pharmacological measures will overlap for a period after the onset of the pandemic, playing a strong role in virus containment. We explored which factors influence the likelihood to adopt two different preventive measures against the COVID-19 pandemic. An online snowball sampling (May-June 2020) collected a total of 448 questionnaires in Italy. A Bayesian bivariate Gaussian regression model jointly investigated the willingness to get vaccinated against COVID-19 and to download the national contact tracing app. A mixed-effects cumulative logistic model explored which factors affected the motivation to adopt one of the two preventive measures. Despite both COVID-19 vaccines and tracing apps being indispensable tools to contain the spread of SARS-CoV-2, our results suggest that adherence to the vaccine or to the national contact tracing app is not predicted by the same factors. Therefore, public communication on these measures needs to take in consideration not only the perceived risk associated with COVID-19, but also the trust people place in politics and science, their concerns and doubts about vaccinations, and their employment status. Further, the results suggest that the motivation to comply with these measurements was predominantly to protect others rather than self-protection.

Reasons for Nonuse, Discontinuation of Use, and Acceptance of Additional Functionalities of a COVID-19 Contact Tracing App: Cross-sectional Survey Study

BACKGROUND

In several countries, contact tracing apps (CTAs) have been introduced to warn users if they have had high-risk contacts that could expose them to SARS-CoV-2 and could, therefore, develop COVID-19 or further transmit the virus. For CTAs to be effective, a sufficient critical mass of users is needed. Until now, adoption of these apps in several countries has been limited, resulting in questions on which factors prevent app uptake or stimulate discontinuation of app use.

OBJECTIVE

The aim of this study was to investigate individuals' reasons for not using, or stopping use of, a CTA, in particular, the Coronalert app. Users' and nonusers' attitudes toward the app's potential impact was assessed in Belgium. To further stimulate interest and potential use of a CTA, the study also investigated the population's interest in new functionalities.

METHODS

An online survey was administered in Belgium to a sample of 1850 respondents aged 18 to 64 years. Data were collected between October 30 and November 2, 2020. Sociodemographic differences were assessed between users and nonusers. We analyzed both groups' attitudes toward the potential impact of CTAs and their acceptance of new app functionalities.

RESULTS

Our data showed that 64.9% (1201/1850) of our respondents were nonusers of the CTA under study; this included individuals who did not install the app, those who downloaded but did not activate the app, and those who uninstalled the app. While we did not find any sociodemographic differences between users and nonusers, attitudes toward the app and its functionalities seemed to differ. The main reasons for not downloading and using the app were a perceived lack of advantages (308/991, 31.1%), worries about privacy (290/991, 29.3%), and, to a lesser extent, not having a smartphone (183/991, 18.5%). Users of the CTA agreed more with the potential of such apps to mitigate the consequences of the pandemic. Overall, nonusers found the possibility of extending the CTA with future functionalities to be less acceptable than users. However, among users, acceptability also tended to differ. Among users, functionalities relating to access and control, such as digital certificates or "green cards" for events, were less accepted (358/649, 55.2%) than functionalities focusing on informing citizens about the spread of the virus (453/649, 69.8%) or making an appointment to get tested (525/649, 80.9%).

CONCLUSIONS

Our results show that app users were more convinced of the CTA's utility and more inclined to accept new app features than nonusers. Moreover, nonusers had more CTA-related privacy concerns. Therefore, to further stimulate app adoption and use, its potential advantages and privacy-preserving mechanisms need to be stressed. Building further knowledge on the forms of resistance among nonusers is important for responding to these barriers through the app's further development and communication campaigns.

Identifying and addressing digital health risks associated with emergency pandemic response: Problem identification, scoping review, and directions toward evidence-based evaluation

BACKGROUND AND OBJECTIVE

The COVID-19 pandemic has accelerated digital health applications in multifaceted disease management dimensions. This study aims (1) to identify risk issues relating to the rapid development and redeployment of COVID-19 related e-health systems, in primary care, and in the health ecosystems interacting with it and (2) to suggest evidence-based evaluation directions under emergency response.

METHOD

After initial brainstorming of digital health risks posed in this pandemic, a scoping review method was adopted to collect evidence across databases of PubMed, CINAHL, and EMBASE. Peer-review publications, reports, news sources, and websites that credibly identified the challenges relating digital health scaled for COVID-19 were scrutinized. Additional supporting materials were obtained through snowball sampling and the authors' global digital health networks. Studies satisfying the selection criteria were charted based on their study design, primary care focus, and coverage of e-health areas of risk.

RESULTS

Fifty-eight studies were mapped for qualitative synthesis. Five identified digital health risk areas associated with the pandemic were governance, system design and coordination, information access, service provision, and user (professional and public) reception. We observed that rapid digital health responses may embed challenges in health system thinking, the long-term development of digital health ecosystems, and interoperability of health IT infrastructure, with concomitant weaknesses in existing evaluation theories.

CONCLUSION

Through identifying digital health risks posed during the pandemic, this paper discussed potential directions for next-generation informatics evaluation development, to better prepare for the post-COVID-19 era, a new future epidemic, or other unforeseen global health emergencies. An updated evidence-based approach to health informatics is essential to gain public confidence in digital health across primary and other health sectors.

Public opinion of the Irish “COVID Tracker” digital contact tracing App: A national survey

Objective

This study aims to gather public opinion on the Irish “COVID Tracker” digital contact tracing (DCT) App, with particular focus on App usage, usability, usefulness, technological issues encountered, and potential changes to the App.

Methods

A 35-item online questionnaire was deployed for 10 days in October 2020, 3 months after the launch of the Irish DCT App.

Results

A total of 2889 completed responses were recorded, with 2553 (88%) respondents currently using the App. Although four in five users felt the App is easy to download, is easy to use and looks professional, 615 users (22%) felt it had slowed down their phone, and 757 (28%) felt it had a negative effect on battery life. Seventy-nine percent of respondents reported the App's main function is to aid contact tracing. Inclusion of national COVID-19 trends is a useful ancillary function according to 87% of respondents, and there was an appetite for more granular local data. Overall, 1265 (44%) respondents believed the App is helping the national effort, while 1089 (38%) were unsure.

Conclusions

DCT Apps may potentially augment traditional contact tracing methods. Despite some reports of negative effects on phone performance, just 7% of users who have tried the App have deleted it. Ancillary functionality, such as up-to-date regional COVID-19, may encourage DCT App use. This study describes general positivity toward the Irish COVID Tracker App among users but also highlights the need for transparency on effectiveness of App-enabled contact tracing and for study of non-users to better establish barriers to use.

Digital Contact Tracing and COVID-19: Design, Deployment, and Current Use in Italy

The technological innovation of digital contact tracing (DCT) has certainly characterized the COVID-19 pandemic, as compared to the previous ones. Based on the first studies, considerable support was expected from smartphone applications (“apps”) for DCT. This commentary focuses on digital contact tracing. Its contributions are threefold: (a) Recall the initial expectations of these technologies and the state of diffusion. (b) Deal with the introduction of the app “Immuni” in Italy, while also highlighting the initiatives undertaken at the government level. (c) Report the state of diffusion and use of this App. The commentary ends by proposing some reflections on the continuation of this investigation in Italy.

Non-Pharmaceutical Interventions against COVID-19 Pandemic: Review of Contact Tracing and Social Distancing Technologies, Protocols, Apps, Security and Open Research Directions

The COVID-19 Pandemic has punched a devastating blow on the majority of the world's population. Millions of people have been infected while hundreds of thousands have died of the disease throwing many families into mourning and other psychological torments. It has also crippled the economy of many countries of the world leading to job losses, high inflation, and dwindling Gross Domestic Product (GDP). The duo of social distancing and contact tracing are the major technological-based non-pharmaceutical public health intervention strategies adopted for combating the dreaded disease. These technologies have been deployed by different countries around the world to achieve effective and efficient means of maintaining appropriate distance and tracking the transmission pattern of the diseases or identifying those at high risk of infecting others. This paper aims to synthesize the research efforts on contact tracing and social distancing to minimize the spread of COVID-19. The paper critically and comprehensively reviews contact tracing technologies, protocols, and mobile applications (apps) that were recently developed and deployed against the coronavirus disease. Furthermore, the paper discusses social distancing technologies, appropriate methods to maintain distances, regulations, isolation/quarantine, and interaction strategies. In addition, the paper highlights different security/privacy vulnerabilities identified in contact tracing and social distancing technologies and solutions against these vulnerabilities. We also x-rayed the strengths and weaknesses of the various technologies concerning their application in contact tracing and social distancing. Finally, the paper proposed insightful recommendations and open research directions in contact tracing and social distancing that could assist researchers, developers, and governments in implementing new technological methods to combat the menace of COVID-19.

Public Perceptions around mHealth Applications during COVID-19 Pandemic: A Network and Sentiment Analysis of Tweets in Saudi Arabia

A series of mitigation efforts were implemented in response to the COVID-19 pandemic in Saudi Arabia, including the development of mobile health applications (mHealth apps) for the public. Assessing the acceptability of mHealth apps among the public is crucial. This study aimed to use Twitter to understand public perceptions around the use of six Saudi mHealth apps used during COVID-19: “Sehha”, “Mawid”, “Sehhaty”, “Tetamman”, “Tawakkalna”, and “Tabaud”. We used two methodological approaches: network and sentiment analysis. We retrieved Twitter data using specific mHealth apps-related keywords. After including relevant tweets, our final mHealth app networks consisted of a total of 4995 Twitter users and 8666 conversational relationships. The largest networks in size (i.e., the number of users) and volume (i.e., the conversational relationships) among all were “Tawakkalna” followed by “Tabaud”, and their conversations were led by diverse governmental accounts. In contrast, the four remaining mHealth networks were mainly led by the health sector and media. Our sentiment analysis approach included five classes and showed that most conversations were neutral, which included facts or information pieces and general inquires. For the automated sentiment classifier, we used Support Vector Machine with AraVec embeddings as it outperformed the other tested classifiers. The sentiment classifier showed an accuracy, precision, recall, and F1-score of 85%. Future studies can use social media and real-time analytics to improve mHealth apps’ services and user experience, especially during health crises.

The Pandemic, Infodemic, and People's Resilience in India: Viewpoint

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused widespread fear and stress. The pandemic has affected everyone, everywhere, and created systemic inequities, leaving no one behind. In India alone, more than 34,094,373 confirmed COVID-19 cases and 452,454 related deaths have been reported as of October 19, 2021. Around May 2021, the daily number of new COVID-19 cases crossed the 400,000 mark, seriously hampering the health care system. Despite the devastating situation, the public response was seen through their efforts to come forward with innovative ideas for potential ways to combat the pandemic, for instance, dealing with the shortage of oxygen cylinders and hospital bed availability. With increasing COVID-19 vaccination rates since September 2021, along with the diminishing number of daily new cases, the country is conducting preventive and preparatory measures for the third wave. In this article, we propose the pivotal role of public participation and digital solutions to re-establish our society and describe how Sustainable Development Goals (SDGs) can support eHealth initiatives and mitigate infodemics to tackle a postpandemic situation. This viewpoint reflects that the COVID-19 pandemic has featured a need to bring together research findings across disciplines, build greater coherence within the field, and be a driving force for multi-sectoral, cross-disciplinary collaboration. The article also highlights the various needs to develop digital solutions that can be applied to pandemic situations and be reprocessed to focus on other SDGs. Promoting the use of digital health care solutions to implement preventive measures can be enhanced by public empowerment and engagement. Wearable technologies can be efficiently used for remote monitoring or home-based care for patients with chronic conditions. Furthermore, the development and implementation of informational tools can aid the improvement of well-being and dissolve panic-ridden behaviors contributing toward infodemics. Thus, a call to action for an observatory of digital health initiatives on COVID-19 is required to share the main conclusions and lessons learned in terms of resilience, crisis mitigation, and preparedness.

Online User Information Sharing and Government Pandemic Prevention and Control Strategies-Based on Evolutionary Game Model

Background: The sharing and utilization of online users' information has become an important resource for governments to manage COVID-19; however, it also involves the risk of leakage of users' personal information. Online users' sharing decisions regarding personal information and the government's COVID-19 prevention and control decisions influence each other and jointly determine the efficiency of COVID-19 control and prevention. Method: Using the evolutionary game models, this paper examines the behavioral patterns of online users and governments with regard to the sharing and disclosure of COVID-19 information for its prevention and control. Results: This paper deduce the reasons and solutions underlying the contradiction between the privacy risks faced by online users in sharing information and COVID-19 prevention and control efforts. The inconsistency between individual and collective rationality is the root cause of the inefficiency of COVID-19 prevention and control. Conclusions: The reconciliation of privacy protection with COVID-19 prevention and control efficiency can be achieved by providing guidance and incentives to modulate internet users' behavioral expectations.

I use a COVID-19 contact-tracing app. Do you? Regulatory focus and the intention to engage with contact-tracing technology

Based on regulatory focus theory, it is proposed that there is a relationship between the intention to use COVID-19 contact-tracing apps and goal-directed motivation. Two studies tested this proposal. Study 1 examined the relationship between participants’ chronic regulatory focus and the intention to use contact-tracing apps. Apps usage intention was positively associated with prevention focus. A mediation analysis showed that the relationship between prevention focus and apps usage intention was mediated by privacy and information security concerns. The stronger the prevention focus, the weaker the concerns, thus, the stronger the intention to use contact-tracing apps. Study 2 used priming to have participants adopt either a momentary promotion or prevention focus, after which they were asked about their intention to use contact-tracing apps. A situationally induced regulatory focus influenced the intention to use contact-tracing apps. A moderation analysis showed that age moderated the relationship between regulatory focus and apps usage intention.

A simulated measurement for COVID-19 pandemic using the effective reproductive number on an empirical portion of population: epidemiological models

COVID-19 as a global pandemic has had an unprecedented impact on the entire world. Projecting the future spread of the virus in relation to its characteristics for a specific suite of countries against a temporal trend can provide public health guidance to governments and organizations. Therefore, this paper presented an epidemiological comparison of the traditional SEIR model with an extended and modified version of the same model by splitting the infected compartment into asymptomatic mild and symptomatic severe. We then exposed our derived layered model into two distinct case studies with variations in mitigation strategies and non-pharmaceutical interventions (NPIs) as a matter of benchmarking and comparison. We focused on exploring the United Arab Emirates (a small yet urban centre (where clear sequential stages NPIs were implemented). Further, we concentrated on extending the models by utilizing the effective reproductive number (R t) estimated against time, a more realistic than the static R 0, to assess the potential impact of NPIs within each case study. Compared to the traditional SEIR model, the results supported the modified model as being more sensitive in terms of peaks of simulated cases and flattening determinations.

Factors Influencing the Intention of Actors in Hospitals to Use Indoor Positioning Systems: Reasoned Action Approach

BACKGROUND

Indoor positioning systems (IPS) have become increasingly important for several branches of the economy (eg, in shopping malls) but are relatively new to hospitals and underinvestigated in that context. This research analyzes the intention of actors within a hospital to use an IPS to address this gap.

OBJECTIVE

To investigate the intentions of hospital visitors and employees (as the main actors in a hospital) to use an IPS in a hospital.

METHODS

The reasoned action approach was used, according to which the behavior of an individual is caused by behavioral intentions that are affected by (1) a persuasion that represents the individual's attitude toward the behavior, (2) perceived norms that describe the influence of other individuals, and (3) perceived norms that reflect the possibility of the individual influencing the behavior.

RESULTS

The survey responses of 323 hospital visitors and 304 hospital employees were examined separately using SmartPLS 3.3.3. Bootstrapping procedures with 5000 subsamples were used to test the models (one-tailed test with a significance level of .05). The results show that attitude (β=.536; P<.001; f²=.381) and perceived norms (β=.236; P<.001; f²=.087) are predictors of hospital visitors' intention to use an IPS. In addition, attitude (β=.283; P<.001; f²=.114), perceived norms (β=.301; P<.001; f²=.126), and perceived behavioral control (β=.178; P=.005; f²=.062) are predictors of hospital employees' intention to use an IPS.

CONCLUSIONS

This study has two major implications: (1) our extended reasoned action approach model, which takes into account spatial abilities and personal innovativeness, is appropriate for determining hospital visitors' and employees' intention to use an IPS; and (2) hospitals should invest in implementing IPS with a focus on (a) navigational services for hospital visitors and (b) asset tracking for hospital employees.

Industry and workplace characteristics associated with the downloading of a COVID-19 contact tracing app in Japan: a nation-wide cross-sectional study

BACKGROUND

To combat coronavirus disease 2019 (COVID-19), many countries have used contact tracing apps, including Japan's voluntary-use contact-confirming application (COCOA). The current study aimed to identify industry and workplace characteristics associated with the downloading of this COVID-19 contact tracing app.

METHODS

This cross-sectional study of full-time workers used an online survey. Multiple logistic regression analysis was used to evaluate the associations of industry and workplace characteristics with contact tracing app use.

RESULTS

Of the 27,036 participants, 25.1% had downloaded the COCOA. Workers in the public service (adjusted odds ratio [aOR] = 1.29, 95% confidence interval [CI] 1.14-1.45) and information technology (aOR = 1.38, 95% CI 1.20-1.58) industries were more likely to use the app than were those in the manufacturing industry. In contrast, app usage was less common among workers in the retail and wholesale (aOR = 0.87, 95% CI 0.76-0.99) and food/beverage (aOR = 0.81, 95% CI 0.70-0.94) industries, but further adjustment for company size attenuated these associations. Workers at larger companies were more likely to use the app. Compared with permanent employees, the odds of using the app were higher for managers and civil servants but lower for those who were self-employed.

CONCLUSIONS

Downloading of COCOA among Japanese workers was insufficient; thus, the mitigating effect of COCOA on the COVID-19 pandemic is considered to be limited. One possible reason for the under-implementation of the contact tracing app in the retail and wholesale and food/beverage industries is small company size, as suggested by the fully adjusted model results. An awareness campaign should be conducted to promote the widespread use of the contact tracing app in these industries.

The Synergistic Effect of Time of Exposure, Distance and No Use of Personal Protective Equipment in the Determination of SARS-CoV-2 Infection: Results of a Contact Tracing Follow-Up Study in Healthcare Workers

The aim of this study is to assess the effect of contact time, contact distance and the use of personal protective equipment on the determination of SARS-CoV-2 infection in healthcare workers (HCWs). This study consists of an analysis of data gathered for safety reasons at the Sapienza Teaching Hospital Policlinico Umberto I in Rome through the surveillance system that was put into place after the worsening of the COVID-19 pandemic. The studied subjects consist of HCWs who were put under health surveillance, i.e., all employees who were in contact with subjects who were confirmed to have tested positive for SARS-CoV-2. The HCWs under surveillance were monitored for a period encompassing ten days after the date of contact, during which they undertook nasopharyngeal swab tests analysed through RT-PCR (RealStar® SARS-CoV-2 Altona Diagnostic–Germany). Descriptive and univariate analyses have been undertaken, considering the following as risk factors: (a) no personal protective equipment use (PPE); (b) Distance < 1 m between the positive and contact persons; (c) contact time > 15′. Finally, a Cox regression and an analysis of the level of synergism between factors, as specified by Rothman, were carried out. We analysed data from 1273 HCWs. Of these HCWs, 799 (62.8%) were females, with a sample average age of 47.8 years. Thirty-nine (3.1%) tested positive during surveillance. The overall incidence rate was 0.4 per 100 person-days. Time elapsed from the last exposure and a positive RT-PCR result ranged from 2 to 17 days (mean = 7, median = 6 days). In the univariate analysis, a distance <1 m and a contact time > 15′ proved to be risk factors for the SARS-CoV-2 infection, with a hazard ratio (HR) of 2.62 (95% CI: 1.11–6.19) and 3.59 (95% IC: 1.57–8.21), respectively. The synergism analysis found the highest synergism between the “no PPE use” x “Contact time”. The synergy index S remains strongly positive also in the analysis of the factors “no PPE use” x “Distance” and “Time of contact” x “Distance”. This study confirms the absolute need to implement safety protocols during the pandemic and to use the correct PPE within health facilities in order to prevent SARS-CoV-2 infection. The analysis shows that among the factors considered (contact time and distance, no use of PPE), there is a strong synergistic effect.

Learnings from the design and acceptance of the German COVID-19 tracing app for IS-driven crisis management: a design science research

BACKGROUND

This article investigates the research problem of digital solutions to overcome the pandemic, more closely examining the limited effectiveness and scope of the governmental COVID-19 tracing apps, using the German COVID-19 tracing app (Corona-Warn-App) as an example. A well-designed and effective instrument in the technological toolbox is of utmost importance to overcome the pandemic.

METHOD

A multi-methodological design science research approach was applied. In three development and evaluation cycles, we presented, prototyped, and tested user-centered ideas of functional and design improvement. The applied procedure contains (1) a survey featuring 1993 participants from Germany for evaluating the current app, (2) a gathering of recommendations from epidemiologists and from a focus group discussion with IT and health experts identifying relevant functional requirements, and (3) an online survey combined with testing our prototype with 53 participants to evaluate the enhanced tracing app.

RESULTS

This contribution presents 14 identified issues of the German COVID-19 tracing app, six meta-requirements, and three design principles for COVID-19 tracing apps and future pandemic apps (e.g., more user involvement and transparency). Using an interactive prototype, this study presents an extended pandemic app, containing 13 potential front-end (i.e., information on the regional infection situation, education and health literacy, crowd and event notification) and six potential back-end functional requirements (i.e., ongoing modification of risk score calculation, indoor versus outdoor). In addition, a user story approach for the COVID-19 tracing app was derived from the findings, supporting a holistic development approach.

CONCLUSION

Throughout this study, practical relevant findings can be directly transferred to the German and other international COVID-19 tracing applications. Moreover, we apply our findings to crisis management theory-particularly pandemic-related apps-and derive interdisciplinary learnings. It might be recommendable for the involved decision-makers and stakeholders to forego classic application management and switch to using an agile setup, which allows for a more flexible reaction to upcoming changes. It is even more important for governments to have a well-established, flexible, design-oriented process for creating and adapting technology to handle a crisis, as this pandemic will not be the last one.