The Dutch COVID-19 Contact Tracing App (the CoronaMelder): Usability Study

Abstract

Background Adoption and evaluation of contact tracing tools based on information and communications technology may expand the reach and efficacy of traditional contact tracing methods in fighting COVID-19. The Dutch Ministry of Health, Welfare and Sports initiated and developed CoronaMelder, a COVID-19 contact tracing app. This app is based on a Google/Apple Exposure Notification approach and aims to combat the spread of the coronavirus among individuals by notifying those who are at increased risk of infection due to proximity to someone who later tests positive for COVID-19. The app should support traditional contact tracing by faster tracing and greater reach compared to regular contact tracing procedures. Objective The main goal of this study is to investigate whether the CoronaMelder is able to support traditional contact tracing employed by public health authorities. To achieve this, usability tests were conducted to answer the following question: is the CoronaMelder user-friendly, understandable, reliable and credible, and inclusive? Methods Participants (N=44) of different backgrounds were recruited: youth with varying educational levels, youth with an intellectual disability, migrants, adults (aged 40-64 years), and older adults (aged >65 years) via convenience sampling in the region of Twente in the Netherlands. The app was evaluated with scenario-based, think-aloud usability tests and additional interviews. Findings were recorded via voice recordings, observation notes, and the Dutch User Experience Questionnaire, and some participants wore eye trackers to measure gaze behavior. Results Our results showed that the app is easy to use, although problems occurred with understandability and accessibility. Older adults and youth with a lower education level did not understand why or under what circumstances they would receive notifications, why they must share their key (ie, their assigned identifier), and what happens after sharing. In particular, youth in the lower-education category did not trust or understand Bluetooth signals, or comprehend timing and follow-up activities after a risk exposure notification. Older adults had difficulties multitasking (speaking with a public health worker and simultaneously sharing the key in the app). Public health authorities appeared to be unprepared to receive support from the app during traditional contact tracing because their telephone conversation protocol lacks guidance, explanation, and empathy. Conclusions The study indicated that the CoronaMelder app is easy to use, but participants experienced misunderstandings about its functioning. The perceived lack of clarity led to misconceptions about the app, mostly regarding its usefulness and privacy-preserving mechanisms. Tailored and targeted communication through, for example, public campaigns or social media, is necessary to provide correct information about the app to residents in the Netherlands. Additionally, the app should be presented as part of the national coronavirus measures instead of as a stand-alone app offered to the public. Public health workers should be trained to effectively and empathetically instruct users on how to use the CoronaMelder app.

Reasons for Nonuse, Discontinuation of Use, and Acceptance of Additional Functionalities of a COVID-19 Contact Tracing App: Cross-sectional Survey Study

“…It would, therefore, be important for app developers to gain in-depth insight into the issues that former users have experienced. Moreover, additional usability research could be conducted, as previous research among potential users found issues related to the understandability of CTAs, doubts concerning their usefulness and privacy, and which follow-up actions were expected after a risk exposure notification [ 47 ]. Moreover, previous research analyzing media content concerning the implementation of CTAs has identified thresholds and challenges experienced by users and showed the need to intensify communication about the benefits of using the apps [ 48 ].…”

Predictors to Use Mobile Apps for Monitoring COVID-19 Symptoms and Contact Tracing: Survey Among Dutch Citizens

“…Since this study, the mobile apps, announced by the Dutch Government in April 2020, have been developed and implemented. In a recent study by Bente et al [ 15 ], the contact tracing app (the CoronaMelder) was tested for usability, and was found easy to use. A comparable study was executed in Germany by Blom et al [ 16 ].…”

“…Our survey was distributed before the development of the CoronaMelder app in the Netherlands. The study by Bente et al [ 15 ] indicated that during this period there were many misconceptions concerning contact tracing among the Dutch population. It is likely that these short descriptions of the general aim of the 2 mobile apps were insufficient to take those misconceptions away.…”

Appraisal of a Contact Tracing Training Program for COVID-19 in Greece Focusing on Vulnerable Populations

“…The use of technology in the form of digital applications, platforms and artificial intelligence systems has been proposed as a possible strategy to increase the coverage and effectiveness of contact tracing [25][26][27][28][29][30]. However, issues around privacy, administrative organisation, legal, ethical and cultural considerations have emerged as hurdles to the wider use of technological platforms that could contribute to the effectiveness of contact tracing services [31][32][33][34][35][36]. In addition, the real impact and effectiveness of various technological approaches has not been vigorously evaluated and more research is needed [37,38].…”