Challenges for Nontechnical Implementation of Digital Proximity Tracing During the COVID-19 Pandemic: Media Analysis of the SwissCovid App

Abstract

Background Several countries have released digital proximity tracing (DPT) apps to complement manual contact tracing for combatting the SARS-CoV-2 pandemic. DPT aims to notify app users about proximity exposures to persons infected with SARS-CoV-2 so that they can self-quarantine. The success of DPT apps depends on user acceptance and the embedding of DPT into the pandemic mitigation strategy. Objective By searching for media articles published during the first 3 months after DPT launch, the implementation of DPT in Switzerland was evaluated to inform similar undertakings in other countries. The second aim of the study was to create a link between reported DPT implementation challenges and normalization process theory for planning and optimizing complex digital health interventions, which can provide useful guidance for decision-making in DPT design and implementation. Methods A Swiss media database was searched for articles on the Swiss DPT app (SwissCovid) published in German or French between July 4 and October 3, 2020. In a structured process, topics were extracted and clustered manually from articles that were deemed pertinent. Extracted topics were mapped to four NPT constructs, which reflected the flow of intervention development from planning, stakeholder onboarding, and execution to critical appraisal. Coherence constructs describe sense-making by stakeholders, cognitive participation constructs reflect participants’ efforts to create engagement with the intervention, collective actions refer to intervention execution and joint stakeholder efforts to make the intervention work, and reflexive monitoring refers to collective risk-benefit appraisals to create improvements. Results Out of 94 articles deemed pertinent and selected for closer inspection, 38 provided unique information on implementation challenges. Five challenge areas were identified: communication challenges, challenges for DPT to interface with other processes, fear of resource competition with established pandemic mitigation measures, unclear DPT effectiveness, and obstacles to greater user coverage and compliance. Specifically, several articles mentioned unclear DPT benefits to affect commitment and to raise fears among different health system actors regarding resource competition. Moreover, media reports indicated process interface challenges such as delays or unclear responsibilities in the notification cascade, as well as misunderstandings and unmet communication needs from health system actors. Finally, reports suggested misaligned incentives, not only for app usage by the public but also for process engagement by other actors in the app notification cascade. NPT provided a well-fitting framework to contextualize the different DPT implementation challenges and to highlight improvement strategies, namely a better alignment of stakeholder incentives, or stakeholder-specific communication to address their concerns about DPT. Conclusions Early experiences from one of the first adopters of DPT indicate that nontechnical implementation challenges may affect the effectiveness of DPT. The NPT analysis provides a novel perspective on DPT implementation and stresses the need for stakeholder inclusion in development and operationalization.

Using Venn Diagrams to Evaluate Digital Contact Tracing: Panel Survey Analysis

“…The Swiss digital proximity tracing app (SwissCovid app) was launched on June 25, 2020. The adoption of the app in the Swiss health care system and pandemic mitigation response has been described extensively in previous studies [ 14 , 19 ]. The SwissCovid app employs a decentralized privacy-preserving proximity tracing protocol [ 2 ], has been downloaded almost 3 million times [ 20 ] for a population of 8.4 million in Switzerland, and has an estimated 1.7 million active users.…”

A Data-Driven Simulation of the Exposure Notification Cascade for Digital Contact Tracing of SARS-CoV-2 in Zurich, Switzerland

“…Our study is based on the premise that DCT apps represent a complex intervention that depends on the actions of app users and other players within a health system. A media analysis from Switzerland 22 previously reported on implementation challenges for DCT, including delays in the provision of upload authorization codes to app users with positive test results. Our study confirms these observations and presents indicators for a more targeted monitoring of specific procedures along the notification cascade that pose potential bottlenecks.…”

Adherence and Association of Digital Proximity Tracing App Notifications With Earlier Time to Quarantine: Results From the Zurich SARS-CoV-2 Cohort Study

“…Only few empirical analyses on the effectiveness of SwissCovid exist. Two studies identified factors associated with DPT app uptake and reasons for non-use [ 20 ], as well as challenges related to the implementation of SwissCovid in Switzerland [ 21 ]. Salathé et al analyzed publicly available performance indicators for SwissCovid, such as number of app downloads and notification codes (CovidCodes) entered, and demonstrated proof-of-principle for the functioning of the app [ 22 ].…”