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Schrills T, Kojan L, Gruner M, Calero Valdez A, Franke T. Effects of User Experience in Automated Information Processing on Perceived Usefulness of Digital Contact-Tracing Apps: Cross-Sectional Survey Study. JMIR Hum Factors 2024; 11:e53940. [PMID: 38916941 PMCID: PMC11234054 DOI: 10.2196/53940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/12/2024] [Accepted: 04/07/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND In pandemic situations, digital contact tracing (DCT) can be an effective way to assess one's risk of infection and inform others in case of infection. DCT apps can support the information gathering and analysis processes of users aiming to trace contacts. However, users' use intention and use of DCT information may depend on the perceived benefits of contact tracing. While existing research has examined acceptance in DCT, automation-related user experience factors have been overlooked. OBJECTIVE We pursued three goals: (1) to analyze how automation-related user experience (ie, perceived trustworthiness, traceability, and usefulness) relates to user behavior toward a DCT app, (2) to contextualize these effects with health behavior factors (ie, threat appraisal and moral obligation), and (3) to collect qualitative data on user demands for improved DCT communication. METHODS Survey data were collected from 317 users of a nationwide-distributed DCT app during the COVID-19 pandemic after it had been in app stores for >1 year using a web-based convenience sample. We assessed automation-related user experience. In addition, we assessed threat appraisal and moral obligation regarding DCT use to estimate a partial least squares structural equation model predicting use intention. To provide practical steps to improve the user experience, we surveyed users' needs for improved communication of information via the app and analyzed their responses using thematic analysis. RESULTS Data validity and perceived usefulness showed a significant correlation of r=0.38 (P<.001), goal congruity and perceived usefulness correlated at r=0.47 (P<.001), and result diagnosticity and perceived usefulness had a strong correlation of r=0.56 (P<.001). In addition, a correlation of r=0.35 (P<.001) was observed between Subjective Information Processing Awareness and perceived usefulness, suggesting that automation-related changes might influence the perceived utility of DCT. Finally, a moderate positive correlation of r=0.47 (P<.001) was found between perceived usefulness and use intention, highlighting the connection between user experience variables and use intention. Partial least squares structural equation modeling explained 55.6% of the variance in use intention, with the strongest direct predictor being perceived trustworthiness (β=.54; P<.001) followed by moral obligation (β=.22; P<.001). Based on the qualitative data, users mainly demanded more detailed information about contacts (eg, place and time of contact). They also wanted to share information (eg, whether they wore a mask) to improve the accuracy and diagnosticity of risk calculation. CONCLUSIONS The perceived result diagnosticity of DCT apps is crucial for perceived trustworthiness and use intention. By designing for high diagnosticity for the user, DCT apps could improve their support in the action regulation of users, resulting in higher perceived trustworthiness and use in pandemic situations. In general, automation-related user experience has greater importance for use intention than general health behavior or experience.
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Affiliation(s)
- Tim Schrills
- Institute for Multimedia and Interactive Systems, Universität zu Lübeck, Lübeck, Germany
| | - Lilian Kojan
- Institute for Multimedia and Interactive Systems, Universität zu Lübeck, Lübeck, Germany
| | - Marthe Gruner
- Institute for Multimedia and Interactive Systems, Universität zu Lübeck, Lübeck, Germany
| | - André Calero Valdez
- Institute for Multimedia and Interactive Systems, Universität zu Lübeck, Lübeck, Germany
| | - Thomas Franke
- Institute for Multimedia and Interactive Systems, Universität zu Lübeck, Lübeck, Germany
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Stokes K, Piaggio D, De Micco F, Zarro M, De Benedictis A, Tambone V, Moon M, Maccaro A, Pecchia L. The Use of Contact Tracing Technologies for Infection Prevention and Control Purposes in Nosocomial Settings: A Systematic Literature Review. Infect Dis Rep 2024; 16:519-530. [PMID: 38920895 PMCID: PMC11203438 DOI: 10.3390/idr16030039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/29/2024] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Pandemic management and preparedness are more needed than ever before and there is widespread governmental interest in learning from the COVID-19 pandemic in order to ensure the availability of evidence-based Infection Prevention and Control measures. Contact tracing is integral to Infection Prevention and Control, facilitating breaks in the chain of transmission in a targeted way, identifying individuals who have come into contact with an infected person, and providing them with instruction/advice relating to testing, medical advice and/or self-isolation. AIM This study aims to improve our understanding of the use of contact tracing technologies in healthcare settings. This research seeks to contribute to the field of Infection Prevention and Control by investigating how these technologies can mitigate the spread of nosocomial infections. Ultimately, this study aims to improve the quality and safety of healthcare delivery. METHODS A systematic literature review was conducted, and journal articles investigating the use of contact tracing technologies in healthcare settings were retrieved from databases held on the OvidSP platform between March and September 2022, with no date for a lower limit. RESULTS In total, 277 studies were retrieved and screened, and 14 studies were finally included in the systematic literature review. Most studies investigated proximity sensing technologies, reporting promising results. However, studies were limited by small sample sizes and confounding factors, revealing contact tracing technologies remain at a nascent stage. Investment in research and development of new testing technologies is necessary to strengthen national and international contact tracing capabilities. CONCLUSION This review aims to contribute to those who intend to create robust surveillance systems and implement infectious disease reporting protocols.
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Affiliation(s)
- Katy Stokes
- Applied Biomedical Signal Processing Intelligent eHealth Laboratory, School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (K.S.); (D.P.); (M.Z.); (A.M.); (L.P.)
| | - Davide Piaggio
- Applied Biomedical Signal Processing Intelligent eHealth Laboratory, School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (K.S.); (D.P.); (M.Z.); (A.M.); (L.P.)
| | - Francesco De Micco
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy;
- Department of Clinical Affair, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy;
| | - Marianna Zarro
- Applied Biomedical Signal Processing Intelligent eHealth Laboratory, School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (K.S.); (D.P.); (M.Z.); (A.M.); (L.P.)
| | - Anna De Benedictis
- Department of Clinical Affair, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy;
- Research Unit of Nursing Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy
| | - Vittoradolfo Tambone
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy;
| | - Madison Moon
- Infection Prevention and Control Consultant, Toronto, M4Y 3C8, Canada;
| | - Alessia Maccaro
- Applied Biomedical Signal Processing Intelligent eHealth Laboratory, School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (K.S.); (D.P.); (M.Z.); (A.M.); (L.P.)
| | - Leandro Pecchia
- Applied Biomedical Signal Processing Intelligent eHealth Laboratory, School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (K.S.); (D.P.); (M.Z.); (A.M.); (L.P.)
- Biomedical Engineering (Electronic and Informatics Bioengineering), Università Campus Bio-Medico di Roma, 00128 Roma, Italy
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Galvão WR, Castro Silva LK, Viana RT, Oliveira PHA, Jucá RVBDM, Martins HR, Rabelo M, Fachin-Martins E, Lima LAO. Application of the participatory design in the testing of a baropodometric insole prototype for weight-bearing asymmetry after a stroke: A qualitative study. Hong Kong J Occup Ther 2024; 37:21-30. [PMID: 38912104 PMCID: PMC11192430 DOI: 10.1177/15691861241241776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 03/10/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Currently studies indicate the need to incorporate the user`s perspective in the testing of new assistive technologies. The objective of this paper is to test a baropodometric insole prototype for monitoring and treatment weight-bearing asymmetry, according to the Participatory Design. Methods We used a qualitative case study approach during the testing phase of the baropodometric insole prototype. The focus group approach addressed topics related to the experience and accessibility of the potential user in conjunction with professionals, researchers, and physiotherapy students. Facilitators, barriers, and requirements for the device were collected through audio recordings of the discussions during and after prototype testing. Results Key steps in the prototype testing process were divided into (1) Test of the prototype according to the Participatory Design, divided into Who, When, How, and Why the potential user was involved in the study; and (2) Facilitators, barriers and requirements to improve the prototype. Conclusions The baropodometric insole prototype can be seen as a promising device for monitoring and treating weight-bearing asymmetry.
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Rashidian M, Malek MR, Sadeghi-Niaraki A, Choi SM. Epidemic exposure risk assessment in digital contact tracing: A fuzzy logic approach. Digit Health 2024; 10:20552076241261929. [PMID: 39055785 PMCID: PMC11271102 DOI: 10.1177/20552076241261929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/29/2024] [Indexed: 07/27/2024] Open
Abstract
Background Bluetooth low energy (BLE)-based contact-tracing applications were widely used during the COVID-19 pandemic. However, the use of only the received signal strength feature for proximity calculations may not be adaptable to different virus variants or scalable for other potential epidemic diseases. Objective This study presents a novel framework in regard to evaluating and classifying personal exposure risk that considers both contact features, which include distance and length of contact, and environment features, which include crowd size and the number of recently infected cases in the environment. The framework utilizes a fuzzy expert system that is adaptable to different virus variants. Methods The proposed method was tested on two viruses with different close contact features, which used four membership functions and 256 fuzzy rule sets. Results The proposed framework classified personal exposure risks into four classes, which include low, medium, high, and too high risk. The empirical results showed that the fuzzy logic-based approach reduced the number of false positive cases and demonstrated better accuracy and precision than the current BLE-only approaches. Conclusions The proposed framework provides a more practical and adaptable method in regard to assessing exposure risks in real-world scenarios. It has the potential to be scalable and adaptable to different virus variants and other potential epidemic diseases by considering both contact and environment features. These findings may be useful in order to develop more effective digital contact-tracing applications and policies.
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Affiliation(s)
- Mohsen Rashidian
- Ubiquitous and Mobile GIS Research Lab., Faculty of Geodesy and Geomatics Engineering, K.N. Toosi University of Technology, Tehran Iran
| | - Mohammad Reza Malek
- Ubiquitous and Mobile GIS Research Lab., Faculty of Geodesy and Geomatics Engineering, K.N. Toosi University of Technology, Tehran Iran
| | - Abolghasem Sadeghi-Niaraki
- Department of Computer Science & Engineering and Convergence Engineering for Intelligent Drone, XR Research Center, Sejong University, Seoul, Republic of Korea
| | - Soo-Mi Choi
- Department of Computer Science & Engineering and Convergence Engineering for Intelligent Drone, XR Research Center, Sejong University, Seoul, Republic of Korea
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Ryan RE, Silke C, Parkhill A, Virgona A, Merner B, Hurley S, Walsh L, de Moel-Mandel C, Schonfeld L, Edwards AG, Kaufman J, Cooper A, Chung RKY, Solo K, Hellard M, Di Tanna GL, Pedrana A, Saich F, Hill S. Communication to promote and support physical distancing for COVID-19 prevention and control. Cochrane Database Syst Rev 2023; 10:CD015144. [PMID: 37811673 PMCID: PMC10561351 DOI: 10.1002/14651858.cd015144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND This review is an update of a rapid review undertaken in 2020 to identify relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control. The rapid review was published when little was known about transmission, treatment or future vaccination, and when physical distancing measures (isolation, quarantine, contact tracing, crowd avoidance, work and school measures) were the cornerstone of public health responses globally. This updated review includes more recent evidence to extend what we know about effective pandemic public health communication. This includes considerations of changes needed over time to maintain responsiveness to pandemic transmission waves, the (in)equities and variable needs of groups within communities due to the pandemic, and highlights again the critical role of effective communication as integral to the public health response. OBJECTIVES To update the evidence on the question 'What are relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control?', our primary focus was communication approaches to promote and support acceptance, uptake and adherence to physical distancing. SECONDARY OBJECTIVE to explore and identify key elements of effective communication for physical distancing measures for different (diverse) populations and groups. SEARCH METHODS We searched MEDLINE, Embase and Cochrane Library databases from inception, with searches for this update including the period 1 January 2020 to 18 August 2021. Systematic review and study repositories and grey literature sources were searched in August 2021 and guidelines identified for the eCOVID19 Recommendations Map were screened (November 2021). SELECTION CRITERIA Guidelines or reviews focusing on communication (information, education, reminders, facilitating decision-making, skills acquisition, supporting behaviour change, support, involvement in decision-making) related to physical distancing measures for prevention and/or control of COVID-19 or selected other diseases (sudden acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, Ebola virus disease (EVD) or tuberculosis (TB)) were included. New evidence was added to guidelines, reviews and primary studies included in the 2020 review. DATA COLLECTION AND ANALYSIS Methods were based on the original rapid review, using methods developed by McMaster University and informed by Cochrane rapid review guidance. Screening, data extraction, quality assessment and synthesis were conducted by one author and checked by a second author. Synthesis of results was conducted using modified framework analysis, with themes from the original review used as an initial framework. MAIN RESULTS This review update includes 68 studies, with 17 guidelines and 20 reviews added to the original 31 studies. Synthesis identified six major themes, which can be used to inform policy and decision-making related to planning and implementing communication about a public health emergency and measures to protect the community. Theme 1: Strengthening public trust and countering misinformation: essential foundations for effective public health communication Recognising the key role of public trust is essential. Working to build and maintain trust over time underpins the success of public health communications and, therefore, the effectiveness of public health prevention measures. Theme 2: Two-way communication: involving communities to improve the dissemination, accessibility and acceptability of information Two-way communication (engagement) with the public is needed over the course of a public health emergency: at first, recognition of a health threat (despite uncertainties), and regularly as public health measures are introduced or adjusted. Engagement needs to be embedded at all stages of the response and inform tailoring of communications and implementation of public health measures over time. Theme 3: Development of and preparation for public communication: target audience, equity and tailoring Communication and information must be tailored to reach all groups within populations, and explicitly consider existing inequities and the needs of disadvantaged groups, including those who are underserved, vulnerable, from diverse cultural or language groups, or who have lower educational attainment. Awareness that implementing public health measures may magnify existing or emerging inequities is also needed in response planning, enactment and adjustment over time. Theme 4: Public communication features: content, timing and duration, delivery Public communication needs to be based on clear, consistent, actionable and timely (up-to-date) information about preventive measures, including the benefits (whether for individual, social groupings or wider society), harms (likewise) and rationale for use, and include information about supports available to help follow recommended measures. Communication needs to occur through multiple channels and/or formats to build public trust and reach more of the community. Theme 5: Supporting behaviour change at individual and population levels Supporting implementation of public health measures with practical supports and services (e.g. essential supplies, financial support) is critical. Information about available supports must be widely disseminated and well understood. Supports and communication related to them require flexibility and tailoring to explicitly consider community needs, including those of vulnerable groups. Proactively monitoring and countering stigma related to preventive measures (e.g. quarantine) is also necessary to support adherence. Theme 6: Fostering and sustaining receptiveness and responsiveness to public health communication Efforts to foster and sustain public receptiveness and responsiveness to public health communication are needed throughout a public health emergency. Trust, acceptance and behaviours change over time, and communication needs to be adaptive and responsive to these changing needs. Ongoing community engagement efforts should inform communication and public health response measures. AUTHORS' CONCLUSIONS Implications for practice Evidence highlights the critical role of communication throughout a public health emergency. Like any intervention, communication can be done well or poorly, but the consequences of poor communication during a pandemic may mean the difference between life and death. The approaches to effective communication identified in this review can be used by policymakers and decision-makers, working closely with communication teams, to plan, implement and adjust public communications over the course of a public health emergency like the COVID-19 pandemic. Implications for research Despite massive growth in research during the COVID-19 period, gaps in the evidence persist and require high-quality, meaningful research. This includes investigating the experiences of people at heightened COVID-19 risk, and identifying barriers to implementing public communication and protective health measures particular to lower- and middle-income countries, and how to overcome these.
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Affiliation(s)
- Rebecca E Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Charlotte Silke
- UNESCO Child & Family Research Centre, School of Political Science & Sociology, University of Galway, Galway, Ireland
| | - Anne Parkhill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Ariane Virgona
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Shauna Hurley
- Cochrane Australia, School of Public Health & Preventive Medicine, Melbourne, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
- Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, Australia
- Burnet Institute, Melbourne, Australia
| | | | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Adrian Gk Edwards
- Wales COVID-19 Evidence Centre, Cardiff University, 8th floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN , UK
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, 8th floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, UK
| | - Jessica Kaufman
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
- Vaccine Uptake Group, Murdoch Children's Research Institute , The Royal Children's Hospital, Parkville, Australia
| | - Alison Cooper
- Wales COVID-19 Evidence Centre, Cardiff University, 8th floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN , UK
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, 8th floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4XN, UK
| | | | - Karla Solo
- GRADE McMaster & Cochrane Canada, Health Research Methods, Evidence & Impact, McMaster University , Hamilton, Ontario , Canada
| | | | - Gian Luca Di Tanna
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | | | | | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Pihlajamäki M, Wickström S, Puranen K, Helve O, Yrttiaho A, Siira L. Implementing and Maintaining a SARS-CoV-2 Exposure Notification Application for Mobile Phones: The Finnish Experience. JMIR Public Health Surveill 2023; 9:e46563. [PMID: 37440286 PMCID: PMC10375279 DOI: 10.2196/46563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/17/2023] [Accepted: 06/16/2023] [Indexed: 07/14/2023] Open
Abstract
Exposure notification applications (ENAs) or digital proximity tracing apps were used in several countries during the COVID-19 pandemic. In this viewpoint, we share our experience of implementing and running the Finnish ENA (Koronavilkku), one of the national ENAs with the highest proportion of users during the pandemic. With the aim of strengthening public trust and increasing app uptake, there was a strong prioritization of privacy and data security for the end user throughout the ENA development. This, in turn, limited the use of the app as a tool for health care professionals and deeper insight into its potential effectiveness. The ENA was designed to supplement conventional contact tracing, rather than replace it, and to serve as an early warning system and a trigger for action for the user in case of potential exposure. The predefined target of 40% uptake in the population was achieved within 3 months of the ENA launch. We consider easy-to-understand information produced together with communication experts crucial during the changing pandemic situation. This information educated people about the app as one component in mitigating the pandemic. As the pandemic and its mitigation evolved, the ENA also needed adapting and updating. A few months after its launch, Finland joined European interoperability, which allowed the ENA to share information with ENAs of other countries. We added automatic token issuing to the ENA as of mid-2021. If added earlier and more comprehensively, automatization could have more effectively saved resources in health care services and prevented overburdening contact tracing teams, while also notifying potentially exposed individuals quicker and more reliably. In the spring of 2021, the number of active apps started to gradually decline. Quarantine and testing practices for asymptomatic vaccinated individuals following exposure to the virus were eased and home tests became more common, eventually replacing laboratory testing for much of the population. Taken together, this led to decreased token issuance, which weakened the potential public health usefulness of the app. A self-service option for token issuance would likely have prolonged the lifespan of the app. The ENA was discontinued in mid-2022. Regularly conducted surveys would have helped gain timely knowledge on the use and effectiveness of the app for better responding to the changing needs during the pandemic.
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Affiliation(s)
| | - Sara Wickström
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Otto Helve
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Lotta Siira
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Li D, Shelby T, Brault M, Manohar R, Vermund S, Hagaman A, Forastiere L, Caruthers T, Egger E, Wang Y, Manohar N, Manohar P, Davis JL, Zhou X. Implementation of a Hardware-Assisted Bluetooth-Based COVID-19 Tracking Device in a High School: Mixed Methods Study. JMIR Form Res 2023; 7:e39765. [PMID: 36525333 PMCID: PMC10131711 DOI: 10.2196/39765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Contact tracing is a vital public health tool used to prevent the spread of infectious diseases. However, traditional interview-format contact tracing (TCT) is labor-intensive and time-consuming and may be unsustainable for large-scale pandemics such as COVID-19. OBJECTIVE In this study, we aimed to address the limitations of TCT. The Yale School of Engineering developed a Hardware-Assisted Bluetooth-based Infection Tracking (HABIT) device. Following the successful implementation of HABIT in a university setting, this study sought to evaluate the performance and implementation of HABIT in a high school setting using an embedded mixed methods design. METHODS In this pilot implementation study, we first assessed the performance of HABIT using mock case simulations in which we compared contact tracing data collected from mock case interviews (TCT) versus Bluetooth devices (HABIT). For each method, we compared the number of close contacts identified and identification of unique contacts. We then conducted an embedded mixed methods evaluation of the implementation outcomes of HABIT devices using pre- and postimplementation quantitative surveys and qualitative focus group discussions with users and implementers according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. RESULTS In total, 17 students and staff completed mock case simulations in which 161 close contact interactions were detected by interview or Bluetooth devices. We detected significant differences in the number of close contacts detected by interview versus Bluetooth devices (P<.001), with most (127/161, 78.9%) contacts being reported by interview only. However, a significant number (26/161, 16.1%; P<.001) of contacts were uniquely identified by Bluetooth devices. The interface, ease of use, coherence, and appropriateness were highly rated by both faculty and students. HABIT provided emotional security to users. However, the prototype design and technical difficulties presented barriers to the uptake and sustained use of HABIT. CONCLUSIONS Implementation of HABIT in a high school was impeded by technical difficulties leading to decreased engagement and adherence. Nonetheless, HABIT identified a significant number of unique contacts not reported by interview, indicating that electronic technologies may augment traditional contact tracing once user preferences are accommodated and technical glitches are overcome. Participants indicated a high degree of acceptance, citing emotional reassurance and a sense of security with the device.
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Affiliation(s)
- Dan Li
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Tyler Shelby
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Marie Brault
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Rajit Manohar
- Yale School of Engineering and Applied Science, New Haven, CT, United States
| | - Sten Vermund
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Ashley Hagaman
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Laura Forastiere
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Tyler Caruthers
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Emilie Egger
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Yizhou Wang
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Nathan Manohar
- IBM T.J. Watson Research Center, Yorktown Heights, NY, United States
| | - Peter Manohar
- Carnegie Mellon University, Pittsburgh, NY, United States
| | - J Lucian Davis
- Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Xin Zhou
- Yale School of Public Health, Yale University, New Haven, CT, United States
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Li H, Zhu Y, Niu Y. Contact Tracing Research: A Literature Review Based on Scientific Collaboration Network. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159311. [PMID: 35954664 PMCID: PMC9367716 DOI: 10.3390/ijerph19159311] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 02/01/2023]
Abstract
Contact tracing is a monitoring process including contact identification, listing, and follow-up, which is a key to slowing down pandemics of infectious diseases, such as COVID-19. In this study, we use the scientific collaboration network technique to explore the evolving history and scientific collaboration patterns of contact tracing. It is observed that the number of articles on the subject remained at a low level before 2020, probably because the practical significance of the contact tracing model was not widely accepted by the academic community. The COVID-19 pandemic has brought an unprecedented research boom to contact tracing, as evidenced by the explosion of the literature after 2020. Tuberculosis, HIV, and other sexually transmitted diseases were common types of diseases studied in contact tracing before 2020. In contrast, research on contact tracing regarding COVID-19 occupies a significantly large proportion after 2000. It is also found from the collaboration networks that academic teams in the field tend to conduct independent research, rather than cross-team collaboration, which is not conducive to knowledge dissemination and information flow.
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Affiliation(s)
- Hui Li
- College of Information Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China;
- Correspondence:
| | - Yifei Zhu
- College of Information Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China;
| | - Yi Niu
- China Publishing Group Digital Media Co., Ltd., Beijing 100007, China;
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Isonne C, De Blasiis MR, Turatto F, Mazzalai E, Marzuillo C, De Vito C, Villari P, Baccolini V. What Went Wrong with the IMMUNI Contact-Tracing App in Italy? A Cross-Sectional Survey on the Attitudes and Experiences among Healthcare University Students. Life (Basel) 2022; 12:life12060871. [PMID: 35743902 PMCID: PMC9225335 DOI: 10.3390/life12060871] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 04/07/2023] Open
Abstract
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.
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10
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Naous D, Bonner M, Humbert M, Legner C. Learning From the Past to Improve the Future. BUSINESS & INFORMATION SYSTEMS ENGINEERING 2022. [PMCID: PMC8853227 DOI: 10.1007/s12599-022-00742-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Contact tracing apps were considered among the first tools to control the spread of COVID-19 and ease lockdown measures. While these apps can be very effective at stopping transmission and saving lives, the level of adoption remains significantly below the expected critical mass. The public debate as well as academic research about contact tracing apps emphasizes general concerns about privacy (and the associated risks) but often disregards the value-added services, as well as benefits, that can result from a larger user base. To address this gap, the study analyzes goal-congruent features as drivers for user adoption. It uses market research techniques – specifically, conjoint analysis – to study individual and group preferences and gain insights into the prescriptive design. While the results confirm the privacy-preserving design of most European contact tracing apps, they emphasize the role of value-added services in addressing heterogeneous user segments to drive user adoption. The findings thereby are of relevance for designing effective contact tracing apps, but also inform the user-oriented design of apps for health and crisis management that rely on sharing sensitive information.
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11
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Luo L, Yang Z, Liang J, Ma Y, Wang H, Hon C, Jiang M, Lin Z, Guan W, Mai Z, Li Y, Mai K, Zeng Z, Tu C, Song J, Liu B, Liu Y, He J, Li H, Li B, Dong H, Miao Y, Fan S, Fan L, Liang X, Li K, Chen C, Deng H, Yang Z, Zhong N. Crucial control measures to contain China's first Delta variant outbreak. Natl Sci Rev 2022; 9:nwac004. [PMID: 35497644 PMCID: PMC9046578 DOI: 10.1093/nsr/nwac004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/11/2021] [Accepted: 12/22/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
SARS-CoV-2 B.1.617.2(Delta) variant flared up in late May in Guangzhou, China. Transmission characteristics of delta variant were analyzed for 153 confirmed cases and two complete transmission chains with 7 generations were fully presented. A rapid transmission occurred in 5 generations within 10 days. The basic reproduction number (R0) was 3.60 (95%CI: 2.50–5.30). After redefining the concept of close contact, the proportion of confirmed cases discovered from close contacts increased from 43% to 100%. With the usage of yellow health code, the potential exposed individuals were self-motivated to take nucleic acid test and regained public access with negative testing result. Facing the massive requirement of screening, novel facilities like makeshift inflatable laboratories were promptly set up as a vital supplement and 17 cases were found with one pre-symptomatic. The dynamic adjustment of these three interventions resulted in the decline of Rt from 5.00 to 1.00 within 9 days. By breaking the transmission chain and eliminating the transmission source through extending the scope of the close contact tracing, health code usage and mass testing, the Guangzhou Delta epidemic was effectively contained.
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Affiliation(s)
- Lei Luo
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangdong, China
| | - Zifeng Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, postcode, P.R. China
- Guangzhou Laboratory, Bio-Island, Guangzhou, 510320, P.R. China
- Guangzhou key laboratory for clinical rapid diagnosis and early warning of infectious diseases
- State Key Laboratory of Quality Research in Chinese Medicine, Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa, Macau SAR, China
| | - Jingyi Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, postcode, P.R. China
- Guangzhou Laboratory, Bio-Island, Guangzhou, 510320, P.R. China
- Macau Institute of Systems Engineering, Macau University of Science and Technology, Macau SAR, China
| | - Yu Ma
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangdong, China
| | - Hui Wang
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangdong, China
| | - Chitin Hon
- Macau Institute of Systems Engineering, Macau University of Science and Technology, Macau SAR, China
| | - Mei Jiang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, postcode, P.R. China
| | - Zhengshi Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, postcode, P.R. China
- Guangzhou Laboratory, Bio-Island, Guangzhou, 510320, P.R. China
| | - Wenda Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, postcode, P.R. China
- Guangzhou Laboratory, Bio-Island, Guangzhou, 510320, P.R. China
| | - Zhitong Mai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, postcode, P.R. China
- Guangzhou Laboratory, Bio-Island, Guangzhou, 510320, P.R. China
- State Key Laboratory of Quality Research in Chinese Medicine, Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Taipa, Macau SAR, China
| | - Yongming Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, postcode, P.R. China
- Guangzhou Laboratory, Bio-Island, Guangzhou, 510320, P.R. China
| | - Kailin Mai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, postcode, P.R. China
- Guangzhou Laboratory, Bio-Island, Guangzhou, 510320, P.R. China
| | - Zhiqi Zeng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, postcode, P.R. China
- Guangzhou Laboratory, Bio-Island, Guangzhou, 510320, P.R. China
| | - Chuanmeizi Tu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, postcode, P.R. China
- Guangzhou Laboratory, Bio-Island, Guangzhou, 510320, P.R. China
| | - Jian Song
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, postcode, P.R. China
- Guangzhou Laboratory, Bio-Island, Guangzhou, 510320, P.R. China
| | - Bin Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, postcode, P.R. China
- Guangzhou Laboratory, Bio-Island, Guangzhou, 510320, P.R. China
| | - Yong Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, postcode, P.R. China
- Kingmed Virology Diagnostic & Translational Center, Guangzhou Kingmed Center for Clinical Laboratory Co., Ltd
| | - Jianfeng He
- Guangdong Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Huiyuan Li
- Kingmed Virology Diagnostic & Translational Center, Guangzhou Kingmed Center for Clinical Laboratory Co., Ltd
| | - Baisheng Li
- Guangdong Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Hang Dong
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangdong, China
| | - Yutian Miao
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangdong, China
| | - Shujun Fan
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangdong, China
| | - Lirui Fan
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangdong, China
| | - Xingyi Liang
- Shunde urban and rural planning information research center, Foshan, Guangdong, China
| | - Ke Li
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangdong, China
| | - Chun Chen
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangdong, China
| | - Huihong Deng
- Guangdong Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Zhicong Yang
- Institute of Public Health, Guangzhou Medical University & Guangzhou Center for Disease Control and Prevention, Guangdong, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, postcode, P.R. China
- Guangzhou Laboratory, Bio-Island, Guangzhou, 510320, P.R. China
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12
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Mahr D, Bloch M. Digital risk distribution and COVID-19: How contact tracing is promoted as a solution to equilibrate public health and economic prosperity during pandemics. Digit Health 2022; 8:20552076221085068. [PMID: 35321020 PMCID: PMC8935150 DOI: 10.1177/20552076221085068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
Digital contact tracing appears as an ideal solution to tackle long-term economic damage due to necessary lockdown measures during a pandemic. This essay shows that the challenge of balancing citizen's health and a functioning society is not just coming up today. Commercial centres were already in the Middle Ages worried about their economic prosperity and adopted isolation measures. Although there are much more data available today, pandemic preparedness remains constrained by temporal and spatial realities, thus limiting public health management to the national state. Based on the examples of China and Switzerland, we elaborate on how individual and collective needs can be balanced differently regarding the implementation of a digital contact tracing system. While China's Health Code App is close to social surveillance, Switzerland has turned away from Europe to develop its own Swiss solution due to disagreement about data protection. It becomes clear that the attempts to properly balance public health and economic prosperity during a pandemic must be constantly readjusted and cannot simply be delegated to a digital technology.
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Affiliation(s)
- Dana Mahr
- Université de Genève Faculté des Sciences, Geneve, Switzerland
| | - Marylaure Bloch
- Institut Confucius, Université de Genève Faculté des lettres, Pregny-Chambésy, Switzerland
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13
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Digital Contact Tracing and COVID-19: Design, Deployment, and Current Use in Italy. Healthcare (Basel) 2021; 10:healthcare10010067. [PMID: 35052231 PMCID: PMC8775620 DOI: 10.3390/healthcare10010067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
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.
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14
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Ross GM. I use a COVID-19 contact-tracing app. Do you? Regulatory focus and the intention to engage with contact-tracing technology. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT DATA INSIGHTS 2021. [PMCID: PMC8695370 DOI: 10.1016/j.jjimei.2021.100045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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15
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Riza E, Kakalou E, Nitsa E, Hodges-Mameletzis I, Goggolidou P, Terzidis A, Cardoso E, Puchner KP, Solomos Z, Pikouli A, Stoupa EP, Kakalou C, Karamagioli E, Pikoulis E. Appraisal of a Contact Tracing Training Program for COVID-19 in Greece Focusing on Vulnerable Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9257. [PMID: 34501844 PMCID: PMC8431650 DOI: 10.3390/ijerph18179257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/15/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contact tracing as an epidemiological strategy has repeatedly contributed to the containment of various past epidemics and succeeded in controlling the spread of disease in the community. Systematic training of contact tracers is crucial in ensuring the effectiveness of epidemic containment. METHODS An intensive training course was offered to 216 health and other professionals who work with vulnerable population groups, such as Roma, refugees, and migrants in Greece, by the scientific team of the postgraduate programme "Global Health-Disaster Medicine" of the Medical School, National and Kapodistrian University of Athens, with the support of the Swiss embassy in Greece. The course was delivered online due to the pandemic restriction measures and was comprised of 16 h over 2 days. The course curriculum was adapted in Greek using, upon agreement, a similar training course to what was developed by the Johns Hopkins University Bloomberg School of Public Health. Evaluation of the course was conducted in order to determine the short term satisfaction from participating in this training course. RESULTS A total of 70% of the course participants completed the evaluation questionnaires and all trainers gave feedback on the course. The training modules were ranked as extremely useful by the majority of the participants and over 50% of the participants specifically stated that the course content was directly related to their work with vulnerable groups. Content about the ethics of contact tracing and the effective communication skills presented were deemed most useful. CONCLUSION The course was well organised and provided the required skills for effective contact tracing. Many course participants intend to use some components in their work with vulnerable populations groups. Contact tracing efforts work best in a systematic and coordinated way and the provision of systematic and organised training can greatly increase its effectiveness.
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Affiliation(s)
- Elena Riza
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (E.R.); (E.N.)
| | - Eleni Kakalou
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Evangelia Nitsa
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, 11527 Athens, Greece; (E.R.); (E.N.)
| | - Ioannis Hodges-Mameletzis
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Paraskevi Goggolidou
- Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton WV1 1LY, UK;
| | - Agis Terzidis
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Eleni Cardoso
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Karl Philipp Puchner
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | | | - Anastasia Pikouli
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Eleni-Panagiota Stoupa
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Christina Kakalou
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Evika Karamagioli
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
| | - Emmanouil Pikoulis
- Postgraduate Programme “Global Health-Disaster Medicine”, Medical School National and Kapodistrian University of Athens, Dilou 1 Street, 11527 Athens, Greece; (E.K.); (I.H.-M.); (A.T.); (E.C.); (K.P.P.); (A.P.); (E.-P.S.); (C.K.); (E.P.)
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