Belief of having had unconfirmed Covid-19 infection reduces willingness to participate in app-based contact tracing

Abstract

Contact tracing and lockdown are health policies being used worldwide to combat the coronavirus (COVID-19). The UK National Health Service (NHS) Track and Trace Service has plans for a nationwide app that notifies the need for self-isolation to those in contact with a person testing positive for COVID-19. To be successful, such an app will require high uptake, the determinants and willingness for which are unclear but essential to understand for effective public health benefit. The objective of this study was to measure the determinants of willingness to participate in an NHS app-based contact-tracing programme using a questionnaire within the Care Information Exchange (CIE)—the largest patient-facing electronic health record in the NHS. Among 47,708 registered NHS users of the CIE, 27% completed a questionnaire asking about willingness to participate in app-based contact tracing, understanding of government advice, mental and physical wellbeing and their healthcare utilisation—related or not to COVID-19. Descriptive statistics are reported alongside univariate and multivariable logistic regression models, with positive or negative responses to a question on app-based contact tracing as the dependent variable. 26.1% of all CIE participants were included in the analysis (N = 12,434, 43.0% male, mean age 55.2). 60.3% of respondents were willing to participate in app-based contact tracing. Out of those who responded ‘no’, 67.2% stated that this was due to privacy concerns. In univariate analysis, worsening mood, fear and anxiety in relation to changes in government rules around lockdown were associated with lower willingness to participate. Multivariable analysis showed that difficulty understanding government rules was associated with a decreased inclination to download the app, with those scoring 1–2 and 3–4 in their understanding of the new government rules being 45% and 27% less inclined to download the contact-tracing app, respectively; when compared to those who rated their understanding as 5–6/10 (OR for 1–2/10 = 0.57 [CI 0.48–0.67]; OR for 3–4/10 = 0.744 [CI 0.64–0.87]), whereas scores of 7–8 and 9–10 showed a 43% and 31% respective increase. Those reporting an unconfirmed belief of having previously had and recovered from COVID-19 were 27% less likely to be willing to download the app; belief of previous recovery from COVID-19 infection OR 0.727 [0.585–0.908]). In this large UK-wide questionnaire of wellbeing in lockdown, a willingness for app-based contact tracing over an appropriate age range is 60%—close to the estimated 56% population uptake, and substantially less than the smartphone-user uptake considered necessary for an app-based contact tracing to be an effective intervention to help suppress an epidemic. Difficulty comprehending government advice and uncertainty of diagnosis, based on a public health policy of not testing to confirm self-reported COVID-19 infection during lockdown, therefore reduce willingness to adopt a government contact-tracing app to a level below the threshold for effectiveness as a tool to suppress an epidemic.

Public acceptance of privacy-encroaching policies to address the COVID-19 pandemic in the United Kingdom

“…There are also similarities between the two sets of results. Similar to us, [ 25 ] found that advanced age (i.e., 80 and above) was associated with decreased likelihood of participation. In addition, a reduced understanding of government rules and advice on the lockdown at the time was associated with reduced willingness to download the app.…”

“…Our results are somewhat more at variance with another recent report on app acceptance in the U.K. [ 25 ]. That study recruited a very large sample (N ≃ 12,500) in mid-May 2020 through the Care Information Exchange (CIE), a patient-facing NHS web platform.…”

“…This high level of endorsement stands in contrast to people’s commonly professed concern for their privacy [ 26 ]. It appears that the British public is prepared to sacrifice some privacy in the interest of public health, in particular when the scenarios are explained in detail (compare our results to those of [ 25 ]).…”

“…Around 60% of participants indicated willingness to download a contact-tracing app, although the study did not elaborate on the app other than to describe it as “an NHS app for your phone (like the one being tested on the Isle of Wight).” The majority of participants who declined participation (67% of that group) indicated that their refusal was due to privacy concerns. There are several possible reasons for the greater rates of endorsement observed here compared to [ 25 ]. In addition to obvious differences between samples (representative vs. self-selected users of an NHS website), we explained our scenarios in greater depth, and the additional information may have swayed people because it explained the public-health benefit of the technology.…”

“…In addition, given the important role of trust, any policy rollout should be accompanied by clear messages about why and how the government is a trustworthy custodian of people’s data. Those messages must also be easy to understand and follow [ 25 ]. This may require the government to explicitly step aside and highlight the fact that the data will be held by trusted institutions, such as the NHS.…”