Objectives The present study explored public’s willingness to use COVID-19 immunity certificates across six different domestic scenarios. Design Cross-sectional online survey. Setting UK representative survey conducted on 3 August 2021. Participants 534 UK residents over 18 years old. Interventions Participants replied to the same set of questions. Primary and secondary outcome measures The primary outcome measure was willingness to use immunity certificates across three different domestic settings: (1) visiting the general practitioner (GP) for a non-urgent health issue; (2) dining in a restaurant and (3) attending a performance in a theatre. For each setting two options, one prioritising convenience (option A) and the other privacy (option B), were offered. Our secondary outcome measures were computed indices from items adapted from the Health Belief Model; attitudes towards sharing immunity status with service providers; prior to COVID-19 lifestyle. In addition, we recorded data about respondents’ sociodemographic characteristics. Results Respondents were more willing to use immunity certificates that prioritised convenience (92%), rather than privacy (76%), when visiting their GP . However, privacy was more favourable in the other two settings (dining in a restaurant (84%) and going to a theatre (83%)) compared with convenience (38% and 39% respectively). Personal beliefs about COVID-19 and immunity certificates were associated with variations in willingness to use these across all scenarios. No variations were observed across sociodemographics and lifestyle. Conclusions The findings of this survey suggest that there is not one-size-fits-all solution for designing immunity certificates. Immunity certificates are complex sociotechnical systems, any attempt to implement these for domestic use should be tailored to different settings and user needs. The design of certification services requires a more evidence-based approach and further research is needed to understand how different settings, design elements (like convenience or privacy) and personal beliefs about the pandemic should inform their design.

/pdf/why-one-size-fits-all-is-not-enough-when-designing-covid-19-3aj6em05.pdf

Why ‘one size fits all’ is not enough when designing COVID-19 immunity certificates for domestic use: a UK-wide cross-sectional online survey

Outcomes, which are the result state or condition from a process or intervention, are essential elements of healthcare system design and an important indicator of performance. They are included in well-known system analysis frameworks such as the Systems Engineering Initiative for Patient Safety (SEIPS) and Cognitive Work Analysis (CWA). However, fewer practical approaches exist for understanding and communicating interactions among healthcare outcomes. This study applies a novel mapping method as a practical approach to collect, aggregate and visualise interrelations among multiple healthcare outcomes. Graphic facilitation mapping sessions with eleven healthcare providers and ten patients with chronic conditions were conducted. Participants created outcome interrelationship maps following a six-step process. Two outcome-based network visualisations were synthesised using network analysis. This outcome-based approach advances how we frame healthcare systems, focussing on accommodating multiple stakeholders' visions, understanding interrelations, and defining trade-offs. This practical approach may complement frameworks such as SEIPS and CWA. Practitioner summary: The presented outcome-based mapping approach can facilitate the understanding of outcomes as part of the interrelated healthcare system. The approach allows the discussion and integration of different stakeholders' outcome priorities to identify critical elements and better inform the development or adaptation of healthcare systems. Abbreviations: SEIPS: engineering initiative for patient safety; CWA: cognitive work analysis; HFE: human factors and ergonomics; AH: abstraction hierarchy; POTS: postural orthostatic tachycardia syndrome; DRM: design research methodology; FA2: forceAtlas2; HbA1c: glycated haemoglobin; NHS: National Health Service; UK: United Kingdom.

https://www.tandfonline.com/doi/pdf/10.1080/00140139.2021.1961018

Multiple outcome interactions in healthcare systems: a participatory outcome mapping approach.

Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

/pdf/why-one-size-fits-all-is-not-enough-when-designing-immunity-14uvmw1ghd.pdf

Why “one size fits all” is not enough when designing immunity certificates for domestic use: a UK wide cross-sectional online survey

This	paper	presents	a	framework	and	process	for	a	visual	language	that	is	developing	as	a	systemic	
visual	method,	and	to	integrate	and	outline	aspects	of	this	synthetic	map	formulation	as	the	
“synthesis	map”	both	with	reference	to	contributing	authors,	but	also	as	a	comparison	to	design	
principles	and	the	method	of	visual	design	language.	In	this	way	the	technique’s	purpose	as	an	
emergent	and	creative	tool	‐	method	can	be	illustrated,	in	contrast	to	the	approaches	of	
infographics,	and	other	visual	map	making	associated	with	design	ideation,	and	design	schema	
representation.		Synthesis	maps	integrate	evidence	and	expertise	in	a	visual	narrative	for	
knowledge	translation	and	communication

Synthesis maps: Systemic design pedagogy, narrative, andintervention

The present short communication paper describes the methodological approach of applying the Health Belief Model to the use COVID-19 immunity certificates in the UK. We designed an online survey including an adaptation of the following Health Belief Model constructs: perceived COVID-19 susceptibility, perceived COVID-19 severity, perceived benefits of using immunity certificates, perceived barriers from using immunity certificates, perceived severity of not using immunity certificates, and perceived vaccination views. The online cross-sectional survey conducted on the 3rd of August 2021 gathered responses from 534 participants aged 18 and older, representative of the UK population in terms of gender, age, and ethnicity.

Using the Health Belief Model to design a questionnaire aimed at measuring people's perceptions regarding COVID-19 immunity certificates

This map presents the COVID-19 health certificate as a complex system.This map is based on the results from the first study (focus group) of the IMMUNE research project.More information about the project: https://immunitypassportsdesign.org/

Mapping COVID-19 Health Certificates as a Complex System (version 1.1)

Implementing COVID-19 immunity certificates without careful consideration of user needs and human factors could put public health at risk, infringe privacy and lead to societal inequalities. There are polarised and complex views among different stakeholders (including academic researchers, service providers and the public) about the feasibility and the ethical, safe, trusted and fair use of immunity certificates. Therefore, there is a clear need to understand the needs, unintended consequences, and risk of implementing immunity certificates before designing services around them. This understanding will prevent compromising human rights and civil liberties, and at the same time, help protect public health and return to normality. This paper presents the application of systems/service approaches as part of the IMMUNE project, a research project funded by the UK Arts and Humanities Research Council (AHRC). IMMUNE has investigated the design of services for immunity certificates in the UK. This research has generated recommendations meaningful to the post-pandemic systems/service design, emphasising the tensions and intertwinement of public health with everyday life.

COVID-19 immunity certificates as complex systems: applying systems approaches to explore needs, risks, and unintended consequences

Various stakeholders in the complex healthcare systems often prioritise and pursue different purposes, values and outcomes. Understanding/sharing/negotiating the trade-offs between them is a critical action in the development and design of complex healthcare systems. Some approaches like work domain analysis or soft systems methodology attempted to map the complex
interactions, but it remains unclear how those maps and visualisations are in line with how people conceptualise in practice. This study aims to explore how designers visualise complex system interactions using healthcare outcomes to define the purpose. A workshop was conducted with 23 designers to generate outcome-based visualisations. The results indicate that designers conceptualise the purpose of the healthcare systems in different ways. Complexity was expressed through organic circles and messy arrows. However, support elements are needed to conduct open visualisations. These results may play a role in developing a visualisation-based method to address the complexity of purpose definition in healthcare.

Holistic outcome-based visualisations for defining the purpose of healthcare system

Rethinking design for a complex world: the systems track

Objectives: To assess what were the main individual factors influencing people9s perception of the importance of using COVID-19 immunity certificates. 

Design: Cross-sectional online survey.
Setting: Nationally representative survey in the UK, conducted on the 3rd of August 2021.

Participants: Responses from 534 participants, aged 18 and older, residents of the UK.

Interventions: This was a cross-sectional survey and each participant replied to the same set of questions.

Primary outcome measure and independent variables: The primary outcome measure (dependent variable) was the participants9 perceived importance of using immunity certificates, computed as an index of six items. The following individual drivers were used as the independent variables: a) personal beliefs about COVID-19 (using constructs adapted from the Health Belief Model), b) personal views on vaccination, c) willingness to share immunity status with service providers, and d) variables related to respondents9 lifestyle and socio-demographic characteristics.

Results: Perceived importance of immunity certificates was higher among respondents who felt that contracting COVID-19 would have a severe negative impact on their health (β=0.2564, p=0.0000) and felt safer if vaccinated (β=0.1552, p=0.0000). The prospect of future economic recovery positively influenced perceived importance of immunity certificates. Respondents who were employed or self-employed (β=-0.2412, p=0.0010), or experienced an increase in income after the COVID-19 pandemic (β=-0.1287, p=0.0020) perceived less important the use of immunity certificates compared to those who were unemployed or had retired or those who had experienced reduction in their income during the pandemic. 

Conclusions: The findings of our survey suggest that more vulnerable members in our society (unemployed or retired and those believing that COVID-19 would have a severe impact on their health) and people who experienced a reduction in income during the pandemic perceived the severity of not using immunity certificates in their daily life as higher.

https://medrxiv.org/content/10.1101/2021.11.12.21266256v1.full.pdf

Individual factors influencing public’s perceptions about the importance of COVID-19 immunity certificates: a cross-sectional online questionnaire survey in the UK

Cecilia Landa-Avila

Papers

Mapping COVID-19 Health Certificates as a Complex System (version 1.1)

COVID-19 immunity certificates as complex systems: applying systems approaches to explore needs, risks, and unintended consequences

Holistic outcome-based visualisations for defining the purpose of healthcare system

Rethinking design for a complex world: the systems track

Individual factors influencing public’s perceptions about the importance of COVID-19 immunity certificates: a cross-sectional online questionnaire survey in the UK