User Experiences of the NZ COVID Tracer App in New Zealand: Thematic Analysis of Interviews

'Barely keeping the wheels on the trolley': A qualitative study of the New Zealand COVID Tracer App

Digital contact tracing apps were developed to help control the spread of COVID-19 but research exploring these apps has underrepresented both 'at-risk' communities and contact tracers. Our study examines perspectives of the New Zealand COVID Tracer app among 53 participants, comprising policy advisors, contact tracers, and Māori, Pacific, and disability stakeholders, underpinned by the theory of social construction of which positions technology within the social context in which it evolves, operates, and is negotiated. Although community stakeholders believed the app helped safeguard communities from COVID-19, the health officials' views on the app's usefulness in contact tracing varied. Participants who oversaw the app's technical development generally perceived it as being more useful, particularly regarding Bluetooth proximity detection, in contrast with contact tracers' perceptions. The findings highlight a disconnection between public sentiment and operational reality in the use of the app and the need for improved collaboration and consultation in future contact tracing responses.

An evaluation of the COVID-19 self-service digital contact tracing system in New Zealand

BACKGROUND

Digital contact tracing (DCT) aims to improve time-to-isolation (timeliness) and find more potentially exposed individuals (sensitivity) to enhance the utility of contact tracing. The aim of this study was to evaluate the public uptake of a DCT self-service survey and its integration with the Bluetooth exposure notification system within the New Zealand Covid Tracer App (NZCTA).

METHODS

We adopted a retrospective cohort study design using community COVID-19 cases from February 2022 to August 2022 in New Zealand (1.2 million cases). We examined the proportion of cases completing a self-service survey and the time to complete the survey by age, sex and ethnicity.

RESULTS

Overall, 66 % of cases completed their self-service survey. Completion was influenced by age, sex and ethnicity. The median completion time was 1.8 h (IQR 0.2, 17.2), with 95 % of those completing this survey doing so within 48 h of case identification. Around 13 % of all survey completers also uploaded their Bluetooth data, which resulted in an average of 663 cases per day notifying 4.5 contacts per case.

CONCLUSION

The combination of high public uptake and rapid response times suggest self-service DCT could be a useful tool for future outbreaks, particularly if implemented in conjunction with manual processes and other DCT tools (e.g. Bluetooth) to address issues related to performance (sensitivity, timeliness), effectiveness, and health equity.

Population and contact tracer uptake of New Zealand's QR-code-based digital contact tracing app for COVID-19

This study aimed to understand the population and contact tracer uptake of the quick response (QR)-code-based function of the New Zealand COVID Tracer App (NZCTA) used for digital contact tracing (DCT). We used a retrospective cohort of all COVID-19 cases between August 2020 and February 2022. Cases of Asian and other ethnicities were 2.6 times (adjusted relative risk (aRR) 2.58, 99 per cent confidence interval (95% CI) 2.18, 3.05) and 1.8 times (aRR 1.81, 95% CI 1.58, 2.06) more likely than Māori cases to generate a token during the Delta period, and this persisted during the Omicron period. Contact tracing organization also influenced location token generation with cases handled by National Case Investigation Service (NCIS) staff being 2.03 (95% CI 1.79, 2.30) times more likely to generate a token than cases managed by clinical staff at local Public Health Units (PHUs). Public uptake and participation in the location-based system independent of contact tracer uptake were estimated at 45%. The positive predictive value (PPV) of the QR code system was estimated to be close to nil for detecting close contacts but close to 100% for detecting casual contacts. Our paper shows that the QR-code-based function of the NZCTA likely made a negligible impact on the COVID-19 response in New Zealand (NZ) in relation to isolating potential close contacts of cases but likely was effective at identifying and notifying casual contacts.

Barriers to adopting digital contact tracing for COVID-19: Experiences in New Zealand

BACKGROUND

Digital contact tracing (DCT) was a central component of the global response to containing COVID-19. Research has raised concerns that DCT could exacerbate inequities, yet the experiences of diverse communities at greater risk from COVID-19 are typically underrepresented.

METHODS

The present study aimed to understand the perceived barriers to the adoption of the app amongst Māori, Pasifika, and disabled people. Focus groups and interviews were undertaken with Māori, Pasifika, and disability sector stakeholders and community participants.

RESULTS

Participants (n = 34) generally expressed willingness to utilise DCT and support its adoption within the communities. Simultaneously, participants revealed how the app could marginalise community members who struggled with the usability and those distrusting of the government's COVID-19 interventions.

CONCLUSIONS

The findings highlight how addressing communication inequality can assist in the development of contact-tracing responses that are both effective and equitable. The study provides insights about the role of information and communication technologies as health resources.

PATIENT OR PUBLIC CONTRIBUTION

Consulting with members of the target communities was central throughout the present study, including recommendations for potential participants, participation in interviews and sharing early findings for feedback. This study reports on focus groups and interviews with individuals from Māori and disability sectors.

Adoption of a COVID-19 Contact Tracing App by Czech Youth: Cross-Cultural Replication Study

BACKGROUND

During the worldwide COVID-19 pandemic crisis, the role of digital contact tracing (DCT) intensified. However, the uptake of this technology expectedly differed among age cohorts and national cultures. Various conceptual tools were introduced to strengthen DCT research from a theoretical perspective. However, little has been done to compare theory-supported findings across different cultural contexts and age cohorts.

OBJECTIVE

Building on the original study conducted in Belgium in April 2020 and theoretically underpinned by the Health Belief Model (HBM), this study attempted to confirm the predictors of DCT adoption in a cultural environment different from the original setting, that is, the Czech Republic. In addition, by using brief qualitative evidence, it aimed to shed light on the possible limitations of the HBM in the examined context and to propose certain extensions of the HBM.

METHODS

A Czech version of the original instrument was administered to a convenience sample of young (aged 18-29 y) Czech adults in November 2020. After filtering, 519 valid responses were obtained and included in the quantitative data analysis, which used structural equation modeling and followed the proposed structure of the relationships among the HBM constructs. Furthermore, a qualitative thematic analysis of the free-text answers was conducted to provide additional insights about the model's validity in the given context.

RESULTS

The proposed measurement model exhibited less optimal fit (root mean square error of approximation=0.065, 90% CI 0.060-0.070) than in the original study (root mean square error of approximation=0.036, 90% CI 0.033-0.039). Nevertheless, perceived benefits and perceived barriers were confirmed as the main, statistically significant predictors of DCT uptake, consistent with the original study (β=.60, P<.001 and β=-.39; P<.001, respectively). Differently from the original study, self-efficacy was not a significant predictor in the strict statistical sense (β=.12; P=.003). In addition, qualitative analysis demonstrated that in the given cohort, perceived barriers was the most frequent theme (166/354, 46.9% of total codes). Under this category, psychological fears and concerns was a subtheme, notably diverging from the original operationalization of the perceived barriers construct. In a similar sense, a role for social influence in DCT uptake processes was suggested by some respondents (12/354, 1.7% of total codes). In summary, the quantitative and qualitative results indicated that the proposed quantitative model seemed to be of limited value in the examined context.

CONCLUSIONS

Future studies should focus on reconceptualizing the 2 underperforming constructs (ie, perceived severity and cues to action) by considering the qualitative findings. This study also provided actionable insights for policy makers and app developers to mitigate DCT adoption issues in the event of a future pandemic caused by unknown viral agents.

Predicting the use of a COVID-19 contact tracing application: A study across two points of measurements

Contact tracing mobile applications (apps) were important in combating the COVID-19 pandemic. Most previous studies predicting contact tracing app use were cross-sectional and not theory-based. This study aimed at contributing to a better understanding of app use intentions and app use by applying an extended version of the protection motivation theory across two measurement points while accounting for the development of the pandemic. A total of N = 1525 participants from Switzerland (Mage = 53.70, SD = 18.73; 47% female; n = 270 completed both assessments) reported on risk perceptions, response efficacy, self-efficacy, social norms, trust in government, trust in the healthcare system, active search of COVID-19-related information, intentions for and actual (self-reported) app use. Analyses included country-specific incidences and death toll. Increases in response-efficacy, self-efficacy, trust in government, and the active search of COVID-19-related information predicted increased app-use intentions. Increases in self-efficacy, intentions, and the active search of COVID-19-related information predicted increased self-reported app use. Risk perceptions, incidence, and death toll were unrelated to both outcomes. Across an aggravation of the pandemic situation, intentions for and app use were primarily related to response-efficacy, self-efficacy, trust in government, and the active search of COVID-19-related information.

Comparing COVID-19 pandemic health responses in two high-income island nations: Iceland and New Zealand

AIMS

We aimed to compare COVID-19 control measures, epidemiological characteristics and economic performance measures in two high-income island nations with small populations, favorable border control options, and relatively good outcomes: Iceland and New Zealand (NZ).

METHODS

We examined peer-reviewed journal articles, official websites, reports, media releases and press articles for data on pandemic preparedness and COVID-19 public health responses from 1 January 2020 to 1 June 2022 in Iceland and NZ. We calculated epidemiological characteristics of the COVID-19 pandemic, as well as measures of economic performance.

RESULTS

Both nations had the lowest excess mortality in the OECD from the start of the pandemic up to June 2022. Iceland pursued a mitigation strategy, never used lockdowns or officially closed its border to foreign nationals, and instead relied on extensive testing and contact tracing early in the pandemic. Meanwhile, NZ pursued an elimination strategy, used a strict national lockdown to stop transmission, and closed its international border to everyone except citizens and permanent residents going through quarantine and testing. Iceland experienced a larger decrease in gross domestic product in 2020 (relative to 2019) than NZ (-8·27% vs. -1·22%, respectively). In late 2021, NZ announced a shift to a suppression strategy and in 2022 began to reopen its border in stages, while Iceland ended all public restrictions on 25 February 2022.

CONCLUSIONS

Many of Iceland's and NZ's pandemic control measures appeared successful and features of the responses in both countries could potentially be adopted by other jurisdictions to address future disease outbreaks and pandemic threats.

Understanding Trust and Changes in Use after a Year with the NHS Covid-19 Contact Tracing App in the United Kingdom: A Longitudinal Mixed-Method Study

Background

Digital contact tracing (DCT) apps have been implemented as a response to the COVID-19 pandemic. Research has focused on understanding acceptance and adoption of these apps, but more work is needed to understand the factors that may contribute to their sustained use. This is key to public health because DCT apps require a high uptake rate to decrease the transmission of the virus within the general population.

Objective

This study aimed to understand changes in the use of the National Health Service Test & Trace (T&T) COVID-19 DCT app and explore how public trust in the app evolved over a 1-year period.

Methods

We conducted a longitudinal mixed methods study consisting of a digital survey in December 2020 followed by another digital survey and interview in November 2021, in which responses from 9 participants were explored in detail. Thematic analysis was used to analyze the interview transcripts. This paper focuses on the thematic analysis to unpack the reasoning behind participants’ answers.

Results

In this paper, 5 themes generated through thematic analysis are discussed: flaws in the T&T app, usefulness and functionality affecting trust in the app, low trust in the UK government, varying degrees of trust in other stakeholders, and public consciousness and compliance dropping over time. Mistrust evolved from participants experiencing sociotechnical flaws in the app and led to concerns about the app’s usefulness. Similarly, mistrust in the government was linked to perceived poor pandemic handling and the creation and procurement of the app. However, more variability in trust in other stakeholders was highlighted depending on perceived competence and intentions. For example, Big Tech companies (ie, Apple and Google), large hospitality venues, and private contractors were seen as more capable, but participants mistrust their intentions, and small hospitality venues, local councils, and the National Health Service (ie, public health system) were seen as well-intentioned but there is mistrust in their ability to handle pandemic matters. Participants reported complying, or not, with T&T and pandemic guidance to different degrees but, overall, observed a drop in compliance over time.

Conclusions

These findings contribute to the wider implications of changes in DCT app use over time for public health. Findings suggest that trust in the wider T&T app ecosystem could be linked to changes in the use of the app; however, further empirical and theoretical work needs to be done to generalize the results because of the small, homogeneous sample. Initial novelty effects occurred with the app, which lessened over time as public concern and media representation of the pandemic decreased and normalization occurred. Trust in the sociotechnical capabilities of the app, stakeholders involved, and salience maintenance of the T&T app in conjunction with other measures are needed for sustained use.

COVID-19 contact-tracing smartphone application usage-The New Zealand COVID Tracer experience

Contact tracing has been a central pillar of the nonpharmaceutical health system response to the COVID-19 pandemic. Countries around the world have devoted unprecedented levels of resources to build up their testing and tracing capabilities, including the development and deployment of smartphone-based applications. Yet despite these nontrivial investments, the body of academic literature evaluating the effects of the smartphone-based applications remains scant and many apps have not delivered the promised benefits (Bano et al. 2021). We contribute to this body of empirical evidence by analysing data on uptake and usage of New Zealand's QR code-based application New Zealand COVID Tracer (NZCT). Our paper uses descriptive statistics and regression analysis to focus on the likelihood of an individual registering to use the application, the likelihood that a registered user will use the application to scan QR codes, and the extent of that usage, measured as the number of codes scanned daily. In addition, we take advantage of the "natural experiment" offered by the decision in August 2021 following the establishment of endemic community transmission of COVID-19 to make use of the application mandatory from 7 September 2021 to assess the effect of this policy on usage. We find that despite increasing numbers of individuals downloading the application over time, the number of active devices and scanning activity was very low, even when community outbreaks occurred (i.e. actual infection risk was higher). Mandating use (separate and distinct from increased infection risk) led to an increase in the number of scans in total via an increase in the number of active devices only.

Explaining citizens' resistance to use digital contact tracing apps: A mixed-methods study

Governments worldwide are using digital contact tracing (DCT) apps as a critical element in their COVID-19 pandemic lockdown exit strategy. Despite substantial investment in research and development, the public's acceptance of DCT apps has been phenomenally low, signaling resistance among potential users. Little is known about why people would resist using the DCT app, a useful innovation that can potentially save millions of human lives. This study explores the determinants and consequences of citizens' resistance to use DCT apps using a sequential two-stage mixed-methods approach. The preliminary qualitative study analyzed interviews of 24 Indian smartphone users who chose not to use or discontinued the DCT app after an initial trial. In the quantitative stage, an integrated model based on innovation resistance theory and distrust theory was tested using the survey data collected from 194 non-adopters of the DCT app from India. The findings revealed that the factors, distrust, value barrier, information privacy concerns, and usage barrier predicted the resistance to the DCT app, and resistance, in turn, predicted intention to use. Additionally, distrust was found to be a key mediator between innovation barriers and resistance. The insights from this study could help the developers and policymakers formulate strategies for implementing DCT interventions during future disease outbreaks.