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Gómez-Bravo R, Ares-Blanco S, Gefaell Larrondo I, Ramos Del Rio L, Adler L, Assenova R, Bakola M, Bayen S, Brutskaya-Stempkovskaya E, Busneag IC, Divjak AĆ, Peña MD, Domeyer PR, Feldmane S, Fitzgerald L, Gjorgjievski D, Gómez-Johansson M, Hanževački M, Ilkov O, Ivanna S, Jandrić-Kočić M, Karathanos VT, Ücüncü E, Kirkovski A, Knežević S, Korkmaz BÇ, Kostić M, Krztoń-Królewiecka A, Kozlovska L, Lingner H, Murauskienė L, Nessler K, Parodi López N, Perjés Á, Petek D, Petrazzuoli F, Petricek G, Sattler M, Seifert B, Serafini A, Sentker T, Ticmane G, Tiili P, Torzsa P, Valtonen K, Vaes B, Vinker S, Neves AL, Guisado-Clavero M, Astier-Peña MP, Hoffmann K. The Use of COVID-19 Mobile Apps in Connecting Patients with Primary Healthcare in 30 Countries: Eurodata Study. Healthcare (Basel) 2024; 12:1420. [PMID: 39057562 PMCID: PMC11275920 DOI: 10.3390/healthcare12141420] [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: 05/22/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has necessitated changes in European healthcare systems, with a significant proportion of COVID-19 cases being managed on an outpatient basis in primary healthcare (PHC). To alleviate the burden on healthcare facilities, many European countries developed contact-tracing apps and symptom checkers to identify potential cases. As the pandemic evolved, the European Union introduced the Digital COVID-19 Certificate for travel, which relies on vaccination, recent recovery, or negative test results. However, the integration between these apps and PHC has not been thoroughly explored in Europe. OBJECTIVE To describe if governmental COVID-19 apps allowed COVID-19 patients to connect with PHC through their apps in Europe and to examine how the Digital COVID-19 Certificate was obtained. METHODOLOGY Design and setting: Retrospective descriptive study in PHC in 30 European countries. An ad hoc, semi-structured questionnaire was developed to collect country-specific data on primary healthcare activity during the COVID-19 pandemic and the use of information technology tools to support medical care from 15 March 2020 to 31 August 2021. Key informants belong to the WONCA Europe network (World Organization of Family Doctors). The data were collected from relevant and reliable official sources, such as governmental websites and guidelines. MAIN OUTCOME MEASURES Patient's first contact with health system, governmental COVID-19 app (name and function), Digital COVID-19 Certification, COVID-19 app connection with PHC. RESULTS Primary care was the first point of care for suspected COVID-19 patients in 28 countries, and 24 countries developed apps to complement classical medical care. The most frequently developed app was for tracing COVID-19 cases (24 countries), followed by the Digital COVID-19 Certificate app (17 countries). Bulgaria, Italy, Serbia, North Macedonia, and Romania had interoperability between PHC and COVID-19 apps, and Poland and Romania's apps considered social needs. CONCLUSIONS COVID-19 apps were widely created during the first pandemic year. Contact tracing was the most frequent function found in the registered apps. Connection with PHC was scarcely developed. In future pandemics, connections between health system levels should be guaranteed to develop and implement effective strategies for managing diseases.
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Affiliation(s)
- Raquel Gómez-Bravo
- Centre Hospitalier Neuro-Psychiatrique, CHNP, 43, Avenue des Alliés, L-9012 Ettelbruck, Luxembourg
- Research Group Self-Regulation and Health, Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Campus Belval, Maison des Sciences Humaines 11, Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg
| | - Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Avenida de la Albufera, 285, 28038 Madrid, Spain
- Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Avda. de Atenas, s/n., 28922 Alcorcón, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, calle del Dr. Esquerdo, 46, 28007 Madrid, Spain
| | - Ileana Gefaell Larrondo
- Fundación de Investigación e Innovación Biosanitaria de Atención Primaria (FIIBAP), 28003 Madrid, Spain
- Research Network on Chronicity, Primary Care and Health Promotion-RICAPPS-(RICORS), 28029 Madrid, Spain
| | - Lourdes Ramos Del Rio
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Avenida de la Albufera, 285, 28038 Madrid, Spain
| | - Limor Adler
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (S.V.)
| | - Radost Assenova
- Department Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Science, University of Ioannina, 451 10 Ioannina, Greece
| | - Sabine Bayen
- Department of General Practice, Faculté de Médicine Henri Warembourg, University of Lille, 59045 Lille, CEDEX 1, France
| | | | - Iliana-Carmen Busneag
- Kinetic Therapy and Special Motricity, Faculty of Physical Education and Sport, “Spiru Haret” University, 030045 Bucharest, Romania
| | | | - Maryher Delphin Peña
- Department of Geriatric Medicine, Hôpitaux Robert Schuman, L-1130 Luxembourg, Luxembourg
| | | | - Sabine Feldmane
- Department of Family Medicine, Faculty of Medicine, Rīga Stradins University, LV-1007 Riga, Latvia
| | - Louise Fitzgerald
- Irish College of General Practice (MICGP), Royal College of Physician (MRCSI), D02 YN77 Dublin, Ireland
| | - Dragan Gjorgjievski
- Center for Family Medicine, Medical Faculty Skopje, 1000 Skopje, North Macedonia
| | | | - Miroslav Hanževački
- Department of Family Medicine, “Andrija Stampar” School of Public Health, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Health Centre Zagreb West, 10000 Zagreb, Croatia
| | - Oksana Ilkov
- Department of Family Medicine and Outpatient Care, Medical Faculty, Uzhhorod National University, Narodna Square, 3, 88000 Uzhhorod, Transcarpathian Region, Ukraine (S.I.)
| | - Shushman Ivanna
- Department of Family Medicine and Outpatient Care, Medical Faculty, Uzhhorod National University, Narodna Square, 3, 88000 Uzhhorod, Transcarpathian Region, Ukraine (S.I.)
| | | | - Vasilis Trifon Karathanos
- Medical Education Unit, Laboratory of Hygiene and Epidemiology, Medical Department, Faculty of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
- General Health System (GHS) Cyprus, 6037 Larnaca, Cyprus
| | - Erva Ücüncü
- Department of Family Medicine, Prof. Dr. Cemil Tascioglu City Hospital, 34384 Istanbul, Turkey
| | - Aleksandar Kirkovski
- Faculty of Medicine, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia
| | - Snežana Knežević
- Department of Medical Sciences, Academy of Applied Studies Polytechnic, 11000 Belgrade, Serbia;
| | | | - Milena Kostić
- Health Center “Dr. Đorđe Kovačević”, 11550 Lazarevac, Serbia
| | - Anna Krztoń-Królewiecka
- Department of Family Medicine, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland
| | - Liga Kozlovska
- Department of Family Medicine, Riga Stradins University, LV-1007 Riga, Latvia (G.T.)
- Rural Family Doctors’ Association of Latvia, LV-4501 Balvi, Latvia
| | - Heidrun Lingner
- Center for Public Health and Healthcare, Department of Medical Psychologie OE5430, Hannover Medical School, 30625 Hannover, Germany
| | - Liubovė Murauskienė
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
| | - Katarzyna Nessler
- Department of Family Medicine, Uniwersytet Jagielloński—Collegium Medicum (UJCM), 31-061 Krakow, Poland
| | - Naldy Parodi López
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Ábel Perjés
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary (P.T.)
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia;
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, 221 00 Malmö, Sweden;
| | - Goranka Petricek
- Department of Family Medicine, “Andrija Stampar” School of Public Health, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Bohumil Seifert
- Institute of General Practice, First Faculty of Medicine, Charles University, Albertov 7, 110 00 Prague, Czech Republic
| | - Alice Serafini
- Azienda Unità Sanitaria Locale di Modena, Laboratorio EduCare, University of Modena and Reggio Emilia, 41121 Reggio Emilia, Italy
| | - Theresa Sentker
- Center for Public Health and Healthcare, Department of Medical Psychologie OE5430, Hannover Medical School, 30625 Hannover, Germany
| | - Gunta Ticmane
- Department of Family Medicine, Riga Stradins University, LV-1007 Riga, Latvia (G.T.)
- Rural Family Doctors’ Association of Latvia, LV-4501 Balvi, Latvia
| | - Paula Tiili
- Communicable Diseases and Infection Control Unit, Wellbeing Services, County of Vantaa and Kerava, P.O. Box 341, 01301 Vantaa, Finland
- Faculty of Medicine, University of Helsinki, P.O. Box 63, 00014 Helsinki, Finland
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, 1085 Budapest, Hungary (P.T.)
| | - Kirsi Valtonen
- Communicable Diseases and Infection Control Unit, Wellbeing Services, County of Vantaa and Kerava, P.O. Box 341, 01301 Vantaa, Finland
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium;
| | - Shlomo Vinker
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel (S.V.)
| | - Ana Luisa Neves
- Department of Primary Care and Public Health, Imperial College London, London SW7 2AZ, UK;
| | - Marina Guisado-Clavero
- Investigation Support Multidisciplinary Unit for Primary Care and Community North Area of Madrid, 28035 Madrid, Spain;
| | - María Pilar Astier-Peña
- Universitas Health Centre, SALUD (Servicio Aragonés de Salud), University of Zaragoza, Andres Vicente 42, 50009 Zaragoza, Spain
| | - Kathryn Hoffmann
- Department of Primary Care Medicine, Medical University of Vienna, 1090 Vienna, Austria
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Wileden L, Anthony D, Campos-Castillo C, Morenoff J. Resident Willingness to Participate in Digital Contact Tracing in a COVID-19 Hotspot: Findings From a Detroit Panel Study. JMIR Public Health Surveill 2023; 9:e39002. [PMID: 36240029 PMCID: PMC9855617 DOI: 10.2196/39002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/06/2022] [Accepted: 10/13/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Digital surveillance tools and health informatics show promise in counteracting diseases but have limited uptake. A notable illustration of the limits of such tools is the general failure of digital contact tracing in the United States in response to COVID-19. OBJECTIVE We investigated the associations between individual characteristics and the willingness to use app-based contact tracing in Detroit, a majority-minority city that experienced multiple waves of COVID-19 outbreaks and deaths since the start of the pandemic. The aim of this study was to examine variations among residents in the willingness to download a contact tracing app on their phones to provide public health officials with information about close COVID-19 contact during summer 2020. METHODS To examine residents' willingness to participate in digital contact tracing, we analyzed data from 2 waves of the Detroit Metro Area Communities Study, a population-based survey of Detroit, Michigan residents. The data captured 1873 responses from 991 Detroit residents collected in June and July 2020. We estimated a series of multilevel logit models to gain insights into differences in the willingness to participate in digital contact tracing across a variety of individual attributes, including race/ethnicity, degree of trust in the government, and level of education, as well as interactions among these variables. RESULTS Our results reflected widespread reluctance to participate in digital contact tracing in response to COVID-19, as less than half (826/1873, 44.1%) of the respondents said they would be willing to participate in app-based contact tracing. Compared to White respondents, Black (odds ratio [OR] 0.45, 95% CI 0.23-0.86) and Latino (OR 0.32, 95% CI 0.11-0.99) respondents were significantly less willing to participate in digital contact tracing. Trust in the government was positively associated with the willingness to participate in digital contact tracing (OR 1.17, 95% CI 1.07-1.27), but this effect was the strongest for White residents (OR 2.14, 95% CI 1.55-2.93). We found similarly divergent patterns of the effects of education by race. While there were no significant differences among noncollege-educated residents, White college-educated residents showed greater willingness to use app-based contact tracing (OR 6.12, 95% CI 1.86-20.15) and Black college-educated residents showed less willingness (OR 0.46, 95% CI 0.26-0.81). CONCLUSIONS Trust in the government and education contribute to Detroit residents' wariness of digital contact tracing, reflecting concerns about surveillance that cut across race but likely arise from different sources. These findings point to the importance of a culturally informed understanding of health hesitancy for future efforts hoping to leverage digital contact tracing. Though contact tracing technologies have the potential to advance public health, unequal uptake may exacerbate disparate impacts of health crises.
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Affiliation(s)
- Lydia Wileden
- Mansueto Institute for Urban Innovation, University of Chicago, Chicago, IL, United States
- Division of the Social Sciences, University of Chicago, Chicago, IL, United States
| | - Denise Anthony
- Department of Health Management & Policy, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- School of Information, University of Michigan, Ann Arbor, MI, United States
- Department of Sociology, University of Michigan, Ann Arbor, MI, United States
| | - Celeste Campos-Castillo
- Department of Media & Information, Michigan State University, East Lansing, MI, United States
| | - Jeffrey Morenoff
- Department of Sociology, University of Michigan, Ann Arbor, MI, United States
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, United States
- Population Studies Center, University of Michigan, Ann Arbor, MI, United States
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