Department of Health Psychology and Applied Biological Psychology, Leuphana University of Lüneburg, Lüneburg, Germany.
Competencies for Digitally-Enhanced Individualized Practice Project, Leuphana University of Lüneburg, Lüneburg, Germany.
J Med Internet Res. 2021 Jun 2;23(6):e27989. doi: 10.2196/27989.
Simulation study results suggest that COVID-19 contact tracing apps have the potential to achieve pandemic control. Concordantly, high app adoption rates were a stipulated prerequisite for success. Early studies on potential adoption were encouraging. Several factors predicting adoption rates were investigated, especially pertaining to user characteristics. Since then, several countries have released COVID-19 contact tracing apps.
This study's primary aim is to investigate the quality characteristics of national European COVID-19 contact tracing apps, thereby shifting attention from user to app characteristics. The secondary aim is to investigate associations between app quality and adoption. Finally, app features contributing to higher app quality were identified.
Eligible COVID-19 contact tracing apps were those released by national health authorities of European Union member states, former member states, and countries of the European Free Trade Association, all countries with comparable legal standards concerning personal data protection and app use voluntariness. The Mobile App Rating Scale was used to assess app quality. An interdisciplinary team, consisting of two health and two human-computer interaction scientists, independently conducted Mobile App Rating Scale ratings. To investigate associations between app quality and adoption rates and infection rates, Bayesian linear regression analyses were conducted.
We discovered 21 national COVID-19 contact tracing apps, all demonstrating high quality overall and high-level functionality, aesthetics, and information quality. However, the average app adoption rate of 22.9% (SD 12.5%) was below the level recommended by simulation studies. Lower levels of engagement-oriented app design were detected, with substantial variations between apps. By regression analyses, the best-case adoption rate was calculated by assuming apps achieve the highest ratings. The mean best-case adoption rates for engagement and overall app quality were 39.5% and 43.6%, respectively. Higher adoption rates were associated with lower cumulative infection rates. Overall, we identified 5 feature categories (symptom assessment and monitoring, regularly updated information, individualization, tracing, and communication) and 14 individual features that contributed to higher app quality. These 14 features were a symptom checker, a symptom diary, statistics on COVID-19, app use, public health instructions and restrictions, information of burden on health care system, assigning personal data, regional updates, control over tracing activity, contact diary, venue check-in, chats, helplines, and app-sharing capacity.
European national health authorities have generally released high quality COVID-19 contact tracing apps, with regard to functionality, aesthetics, and information quality. However, the app's engagement-oriented design generally was of lower quality, even though regression analyses results identify engagement as a promising optimization target to increase adoption rates. Associations between higher app adoption and lower infection rates are consistent with simulation study results, albeit acknowledging that app use might be part of a broader set of protective attitudes and behaviors for self and others. Various features were identified that could guide further engagement-enhancing app development.
模拟研究结果表明，COVID-19 接触者追踪应用程序有可能实现大流行控制。相应地，高应用程序采用率是成功的规定前提。早期对潜在采用的研究是令人鼓舞的。调查了预测采用率的几个因素，特别是与用户特征有关的因素。从那时起，几个国家已经发布了 COVID-19 接触者追踪应用程序。
本研究的主要目的是调查欧洲国家 COVID-19 接触者追踪应用程序的质量特征，从而将注意力从用户转移到应用程序特征上。次要目的是调查应用程序质量与采用率之间的关联。最后，确定了有助于提高应用程序质量的应用程序功能。
合格的 COVID-19 接触者追踪应用程序是指由欧盟成员国、前成员国和欧洲自由贸易联盟国家的国家卫生当局发布的应用程序，所有这些国家在个人数据保护和应用程序使用自愿性方面都具有可比的法律标准。使用移动应用程序评级量表来评估应用程序质量。一个由两名健康和两名人机交互科学家组成的跨学科团队，独立进行了移动应用程序评级量表评级。为了研究应用程序质量与采用率和感染率之间的关联，进行了贝叶斯线性回归分析。
我们发现了 21 个国家的 COVID-19 接触者追踪应用程序，它们的整体质量都很高，具有高水平的功能、美学和信息质量。然而，平均 22.9%（SD 12.5%）的应用程序采用率低于模拟研究建议的水平。检测到以参与为导向的应用程序设计水平较低，各应用程序之间存在很大差异。通过回归分析，假设应用程序达到最高评级，计算出最佳采用率。以参与度和整体应用程序质量衡量的最佳采用率分别为 39.5%和 43.6%。较高的采用率与较低的累积感染率相关。总体而言，我们确定了 5 个功能类别（症状评估和监测、定期更新信息、个性化、追踪和通信）和 14 个单独的功能，这些功能有助于提高应用程序质量。这 14 个功能是症状检查器、症状日记、COVID-19 统计数据、应用程序使用情况、公共卫生说明和限制、对医疗系统负担的信息、个人数据分配、区域更新、追踪活动控制、联系人日记、场地签到、聊天、帮助热线和应用程序共享能力。
欧洲国家卫生当局普遍发布了具有高水平功能、美学和信息质量的 COVID-19 接触者追踪应用程序。然而，应用程序以参与为导向的设计质量普遍较低，尽管回归分析结果表明参与度是提高采用率的一个有前途的优化目标。较高的应用程序采用率与较低的感染率之间的关联与模拟研究结果一致，但需要承认，应用程序使用可能是自我和他人保护态度和行为的更广泛组合的一部分。已经确定了各种可以指导进一步增强参与度的应用程序开发的功能。
