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Journal ArticleDOI

Early Acceptability of a Mobile App for Contact Tracing During the COVID-19 Pandemic in France: National Web-Based Survey.

TL;DR: In this article, the authors evaluated the acceptability of a COVID-19 contact tracing mobile app among the French population and investigated the barriers to its use, finding that only 19.2% of all participants were app-supporting, whereas half of them (504/1003, 50.3%) were reluctant.
Abstract: Background: Several countries have implemented mobile apps in an attempt to trace close contacts of patients with COVID-19 and, in turn, reduce the spread of SARS-CoV-2. However, the effectiveness of this approach depends on the adherence of a large segment of the population. Objective: The aims of this study were to evaluate the acceptability of a COVID-19 contact tracing mobile app among the French population and to investigate the barriers to its use. Methods: The Health Literacy Survey 2019 questioned 1003 people in France during the COVID-19 pandemic on the basis of quota sampling. The survey collected sociodemographic characteristics and health literacy data, as well as information on participants' communication with caregivers, trust in institutions, and COVID-19 knowledge and preventive behaviors. The acceptability of a mobile app for contact tracing was measured by a single question, the responses to which were grouped into three modalities: app-supporting, app-willing, and app-reluctant. Multinomial logistic regression analysis was performed to identify the factors associated with the acceptability of a mobile app during the COVID-19 pandemic. Results: Only 19.2% (193/1003) of all participants were app-supporting, whereas half of them (504/1003, 50.3%) were reluctant. The factors associated with willingness or support toward the contact tracing app included lower financial deprivation (app-willing: adjusted odds ratio [aOR] 0.8, 95% CI 0.69-0.93; app-supporting: aOR 0.7, 95% CI 0.58-0.84) and higher perceived usefulness of using a mobile app to send completed health questionnaires to doctors (app-willing: aOR 2.3, 95% CI 1.70-3.26; app-supporting: aOR 3.1, 95% CI 2.04-4.82). Furthermore, the likelihood of supporting the mobile app increased with age over 60 years (aOR 1.9, 95% CI 1.13-3.22), trust in political representatives (aOR 2.7, 95% CI 1.72-4.23), feeling concerned about the pandemic situation (aOR 2.2, 95% CI 1.47-3.32), and knowledge about the transmission of COVID-19 (aOR 2.0, 95% CI 1.39-2.96). Conclusions: The most socioeconomically precarious people, who are at a higher risk of SARS-CoV-2 infection, are also the most reluctant to using a contact tracing mobile app. Therefore, optimal adherence can only be effective with a targeted discourse on public health benefits to adopt such an app, which should be combined with a reduction in inequalities by acting on structural determinants.

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Citations
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Journal ArticleDOI
Miloslav Szabó1
TL;DR: In this article , the authors explored the determinants and consequences of citizens' resistance to use digital contact tracing (DCT) apps using a sequential two-stage mixed-methods approach.

19 citations

Journal ArticleDOI
TL;DR: In this article, a theoretical framework was developed by extending the Expectation-confirmation model (ECM) of information system continuance with technology trust theory and a contextual factor perceived security and privacy to predict citizens' continuance intentions to use the DCT app.
Abstract: Objectives Digital contact tracing (DCT) was touted as an effective alternative to lockdown and other restrictive measures in controlling the spread of the COVID-19 pandemic. Despite considerable investments in research and development, the usage of DCT apps was found to be phenomenally low across the world. In this context, the current study investigates the factors influencing citizens’ continuance intentions to use the DCT app. Methods A theoretical framework was developed by extending the Expectation-confirmation model (ECM) of Information system continuance with Technology trust theory and a contextual factor perceived security and privacy to predict citizens’ continuance intentions to use the DCT app. The model was empirically tested using data from a field survey of 206 actual users of a DCT app implemented in India. Results The findings reveal that user satisfaction, trust in government, and trust in technology are significant predictors of citizens’ continuance intention. The model demonstrates high explanatory power by explaining 57.8% of the variance of continuance intention. It also validates the role of perceived security and privacy and trust in technology in determining user satisfaction. Conclusion The study makes a theoretical contribution by extending the ECM framework to predict DCT app continuance behavior. The insights from the study could be helpful for developers and policymakers in crafting strategies to improve the usage of DCT apps during future disease outbreaks.

8 citations

Journal ArticleDOI
TL;DR: This paper conducted a survey study on a representative sample of the French adult population and found that a small majority of respondents used TousAntiCovid (55.5%), while 41.0% had never downloaded it and only one-quarter of the respondents (23.3%) used it for contact tracing with Bluetooth.
Abstract: Our study aimed to provide an updated overview of the use of the French contact tracing application, TousAntiCovid, and identify evolutions since the beginning of the pandemic.We conducted a survey study on a representative sample of the French adult population.Our data were collected by the Obervatoire Régional de la Santé (ORS) using a self-administered online questionnaire. This was completed by a sample of 2,022 people stratified to match French official census statistics for gender, age, occupation, and area of housing. We conducted statistical analysis using Python (Pandas - Scipy - Statsmodels) with chi-squared and Wilcoxon rank-sum tests to control for statistical significance.A small majority of respondents used TousAntiCovid (55.5%), while 41.0% had never downloaded it. Only one-quarter of the respondents (23.3%) used it for contact tracing with Bluetooth, while a third (32.2%) used it only for storing their health pass. The app's use increased with education level, income, and younger age. A large majority (85%) of non-vaccinated respondents had never downloaded TousAntiCovid.Our results suggest that the role and use of France's official COVID-19 app TousAntiCovid has evolved in line with the government's strategy; while initially focusing on contact tracing, its development has led to the possibility to store test and vaccination documentation. The survey also confirmed previous results pointing to the lasting differences in socio-economic status in terms of adoption of the app. This is problematic because the long-term nature of the pandemic could require the government to keep a range of strategies open, including contact tracing. Public discussion of the current and future roles of the French contact tracing app is therefore needed.

6 citations

Journal ArticleDOI
TL;DR: In this paper , the authors explored the importance of "well-being" and "trust in the future" in the context of digital contact-tracing apps and found that mobile tracing apps positively affect our well-being and our trust on government.

6 citations

Journal ArticleDOI
TL;DR: In this paper , the authors presented a research model based on UTAUT constructs to study the determinants for adoption of COVID-19-related apps using a questionnaire, and tested the model via confirmatory factor analysis (CFA) and structural equation modeling (SEM) using travelers' data from an insular tourist region.
Abstract: The global health crisis caused by COVID-19 has drastically changed human society in a relatively short time. However, this crisis has offered insights into the different roles that such a worldwide virus plays in the lives of people and how those have been affected, as well as eventually proposing new solutions. From the beginning of the pandemic, technology solutions have featured prominently in virus control and in the frame of reference for international travel, especially contact tracing and passenger locator applications.The objective of this paper is to study specific areas of technology acceptance and adoption following a unified theory of acceptance and use of technology (UTAUT) research model.We presented a research model based on UTAUT constructs to study the determinants for adoption of COVID-19-related apps using a questionnaire. We tested the model via confirmatory factor analysis (CFA) and structural equation modeling (SEM) using travelers' data from an insular tourist region.Our model explained 90.3% of the intention to use (N=9555) and showed an increased understanding of the vital role of safety, security, privacy, and trust in the usage intention of safety apps. Results also showed how the impact of COVID-19 is not a strong predictor of adoption, while age, education level, and social capital are essential moderators of behavioral intention.In terms of scientific impact, the results described here provide important insights and contributions not only for researchers but also for policy and decision makers by explaining the reasons behind the adoption and usage of apps designed for COVID-19.

4 citations

References
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Journal ArticleDOI
08 Jul 2020-Nature
TL;DR: A range of clinical factors associated with COVID-19-related death is quantified in one of the largest cohort studies on this topic so far and includes people of white ethnicity, Black and South Asian people were at higher risk, even after adjustment for other factors.
Abstract: Coronavirus disease 2019 (COVID-19) has rapidly affected mortality worldwide1. There is unprecedented urgency to understand who is most at risk of severe outcomes, and this requires new approaches for the timely analysis of large datasets. Working on behalf of NHS England, we created OpenSAFELY-a secure health analytics platform that covers 40% of all patients in England and holds patient data within the existing data centre of a major vendor of primary care electronic health records. Here we used OpenSAFELY to examine factors associated with COVID-19-related death. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19-related deaths. COVID-19-related death was associated with: being male (hazard ratio (HR) 1.59 (95% confidence interval 1.53-1.65)); greater age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared with people of white ethnicity, Black and South Asian people were at higher risk, even after adjustment for other factors (HR 1.48 (1.29-1.69) and 1.45 (1.32-1.58), respectively). We have quantified a range of clinical factors associated with COVID-19-related death in one of the largest cohort studies on this topic so far. More patient records are rapidly being added to OpenSAFELY, we will update and extend our results regularly.

4,263 citations

Journal ArticleDOI
TL;DR: The impact of timeliness and completeness in various steps of a contact tracing strategy is evaluated using a stochastic mathematical model with explicit time delays between time of infection and symptom onset and between symptom onset, diagnosis by testing, and isolation.
Abstract: Summary Background In countries with declining numbers of confirmed cases of COVID-19, lockdown measures are gradually being lifted. However, even if most physical distancing measures are continued, other public health measures will be needed to control the epidemic. Contact tracing via conventional methods or mobile app technology is central to control strategies during de-escalation of physical distancing. We aimed to identify key factors for a contact tracing strategy to be successful. Methods We evaluated the impact of timeliness and completeness in various steps of a contact tracing strategy using a stochastic mathematical model with explicit time delays between time of infection and symptom onset, and between symptom onset, diagnosis by testing, and isolation (testing delay). The model also includes tracing of close contacts (eg, household members) and casual contacts, followed by testing regardless of symptoms and isolation if testing positive, with different tracing delays and coverages. We computed effective reproduction numbers of a contact tracing strategy (RCTS) for a population with physical distancing measures and various scenarios for isolation of index cases and tracing and quarantine of their contacts. Findings For the most optimistic scenario (testing and tracing delays of 0 days and tracing coverage of 100%), and assuming that around 40% of transmissions occur before symptom onset, the model predicts that the estimated effective reproduction number of 1·2 (with physical distancing only) will be reduced to 0·8 (95% CI 0·7–0·9) by adding contact tracing. The model also shows that a similar reduction can be achieved when testing and tracing coverage is reduced to 80% (RCTS 0·8, 95% CI 0·7–1·0). A testing delay of more than 1 day requires the tracing delay to be at most 1 day or tracing coverage to be at least 80% to keep RCTS below 1. With a testing delay of 3 days or longer, even the most efficient strategy cannot reach RCTS values below 1. The effect of minimising tracing delay (eg, with app-based technology) declines with decreasing coverage of app use, but app-based tracing alone remains more effective than conventional tracing alone even with 20% coverage, reducing the reproduction number by 17·6% compared with 2·5%. The proportion of onward transmissions per index case that can be prevented depends on testing and tracing delays, and given a 0-day tracing delay, ranges from up to 79·9% with a 0-day testing delay to 41·8% with a 3-day testing delay and 4·9% with a 7-day testing delay. Interpretation In our model, minimising testing delay had the largest impact on reducing onward transmissions. Optimising testing and tracing coverage and minimising tracing delays, for instance with app-based technology, further enhanced contact tracing effectiveness, with the potential to prevent up to 80% of all transmissions. Access to testing should therefore be optimised, and mobile app technology might reduce delays in the contact tracing process and optimise contact tracing coverage. Funding ZonMw, Fundacao para a Ciencia e a Tecnologia, and EU Horizon 2020 RECOVER.

614 citations

Journal ArticleDOI
TL;DR: In multivariable analyses, participants who were black, were living below the poverty level, and had low health literacy were more likely to be less worried about COVID-19, to not believe that they would become infected, and to feel less prepared for an outbreak.
Abstract: The evolving COVID-19 outbreak is requiring social distancing and other measures to protect public health. However, messaging has been inconsistent and unclear. This study surveyed 630 adults aged ...

428 citations

Journal ArticleDOI
TL;DR: The COVID-19 pandemic has demonstrated the strong potential of various digital health solutions that have been tested during the crisis and more concerted measures should be implemented to ensure that future digital health initiatives will have a greater impact on the epidemic and meet the most strategic needs.
Abstract: The coronavirus disease (COVID-19) pandemic has created an urgent need for coordinated mechanisms to respond to the outbreak across health sectors, and digital health solutions have been identified as promising approaches to address this challenge. This editorial discusses the current situation regarding digital health solutions to fight COVID-19 as well as the challenges and ethical hurdles to broad and long-term implementation of these solutions. To decrease the risk of infection, telemedicine has been used as a successful health care model in both emergency and primary care. Official communication plans should promote facile and diverse channels to inform people about the pandemic and to avoid rumors and reduce threats to public health. Social media platforms such as Twitter and Google Trends analyses are highly beneficial to model pandemic trends as well as to monitor the evolution of patients’ symptoms or public reaction to the pandemic over time. However, acceptability of digital solutions may face challenges due to potential conflicts with users’ cultural, moral, and religious backgrounds. Digital tools can provide collective public health benefits; however, they may be intrusive and can erode individual freedoms or leave vulnerable populations behind. The COVID-19 pandemic has demonstrated the strong potential of various digital health solutions that have been tested during the crisis. More concerted measures should be implemented to ensure that future digital health initiatives will have a greater impact on the epidemic and meet the most strategic needs to ease the life of people who are at the forefront of the crisis.

230 citations

Journal ArticleDOI
TL;DR: Highlights structural interventions that have yielded health benefits, discusses challenges and opportunities for accelerating improvements in minority health, and proposes recommendations to foster the development of structural interventions likely to advance health disparities research.
Abstract: Health disparities research in the United States over the past 2 decades has yielded considerable progress and contributed to a developing evidence base for interventions that tackle disparities in health status and access to care. However, health disparity interventions have focused primarily on individual and interpersonal factors, which are often limited in their ability to yield sustained improvements. Health disparities emerge and persist through complex mechanisms that include socioeconomic, environmental, and system-level factors. To accelerate the reduction of health disparities and yield enduring health outcomes requires broader approaches that intervene upon these structural determinants. Although an increasing number of innovative programs and policies have been deployed to address structural determinants, few explicitly focused on their impact on minority health and health disparities. Rigorously evaluated, evidence-based structural interventions are needed to address multilevel structural determinants that systemically lead to and perpetuate social and health inequities. This article highlights examples of structural interventions that have yielded health benefits, discusses challenges and opportunities for accelerating improvements in minority health, and proposes recommendations to foster the development of structural interventions likely to advance health disparities research.

185 citations

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