Horizon Digital Economy Research, University of Nottingham, Nottingham, United Kingdom.
School of Computer Science, University of Nottingham, Nottingham, United Kingdom.
J Med Internet Res. 2021 Sep 17;23(9):e29085. doi: 10.2196/29085.
Digital contact tracing is employed to monitor and manage the spread of COVID-19. However, to be effective the system must be adopted by a substantial proportion of the population. Studies of mostly hypothetical contact tracing apps show generally high acceptance, but little is known about the drivers and barriers to adoption of deployed systems.
The aim of this study was to investigate adoption of and attitudes toward the NHS (National Health Service) COVID-19 smartphone app, the digital contact tracing solution in the United Kingdom.
An online survey based on the extended Technology Acceptance Model with the added factor of trust was carried out with a representative sample of the UK population. Statistical analysis showed adoption rates, attitudes toward and trust in the app, and compliance with self-isolation advice and highlighted differences for vulnerable populations (ie, older adults aged 65 years and over and members of Black, Asian, and minority ethnic [BAME] communities).
A total of 1001 participants took part in the study. Around half of the participants who had heard of the NHS COVID-19 mobile phone app (490/963, 50.9%; 95% CI 47.8%-54.0%) had downloaded and kept the app, but more than one-third (345/963, 35.8%; 95% CI 32.8%-38.8%) either did not intend to download it or had deleted it. Significantly more BAME respondents than White respondents had deleted the app (16/115, 13.9%; 95% CI 11.8%-16.0%, vs 65/876, 7.4%; 95% CI 5.8%-9.0%), and significantly more older adults 65 years and over than those under 65 years did not intend to download it (44/127, 34.6%; 95% CI 31.7%-37.5%, vs 220/874, 25.2%; 95% CI 22.5%-27.9%). Broadly, one of the reasons for uptake was to help the NHS and other people, especially among older adults, although significantly fewer BAME participants agreed that they did so to help the NHS. Reported compliance with received notifications to self-isolate was high but was significantly lower than reported intended compliance without received notifications. Only one-fifth (136/699, 19.5%; 95% CI 17.0%-22.0%) of participants understood that the decision to send self-isolation notifications was automated by the app. There were a range of significantly more negative views among BAME participants, including lower trust in the NHS, while older adults were often significantly more positive. Respondents without the app reported significantly lower trust and more negative views toward the app and were less likely to report that they understood how the app works.
While compliance on the part of the approximately 50% of participants who had the app was fairly high, there were issues surrounding trust and understanding that hindered adoption and, therefore, the effectiveness of digital contact tracing, particularly among BAME communities. This study highlights that more needs to be done to improve adoption among groups who are more vulnerable to the effects of the virus in order to enhance uptake and acceptance of contact tracing apps.
数字接触者追踪被用于监测和管理 COVID-19 的传播。然而，要想使其有效，系统必须被相当一部分人口所采用。对主要是假设性接触追踪应用程序的研究表明，一般接受程度较高，但对于部署系统的采用的驱动因素和障碍知之甚少。
本研究旨在调查英国国民保健服务（NHS）COVID-19 智能手机应用程序（数字接触追踪解决方案）的采用情况和人们对其的态度。
对具有代表性的英国人口进行了基于扩展技术接受模型的在线调查，其中增加了信任因素。统计分析显示了应用程序的采用率、态度和信任度，以及对自我隔离建议的遵守情况，并突出了脆弱人群（即 65 岁及以上的老年人和黑人和少数族裔[BAME]社区的成员）的差异。
共有 1001 名参与者参加了这项研究。听说过国民保健服务 COVID-19 手机应用程序的参与者中，约有一半（490/963，50.9%；95%CI 47.8%-54.0%）已经下载并保留了该应用程序，但超过三分之一（345/963，35.8%；95%CI 32.8%-38.8%）的参与者要么不打算下载，要么已经删除了该应用程序。与白人受访者相比，BAME 受访者删除该应用程序的比例明显更高（16/115，13.9%；95%CI 11.8%-16.0%，vs 65/876，7.4%；95%CI 5.8%-9.0%），而 65 岁及以上的老年人比 65 岁以下的人更不打算下载该应用程序（44/127，34.6%；95%CI 31.7%-37.5%，vs 220/874，25.2%；95%CI 22.5%-27.9%）。总的来说，采用该应用程序的原因之一是为了帮助 NHS 和其他人，尤其是老年人，尽管 BAME 参与者中表示这样做是为了帮助 NHS 的比例明显较低。报告的自我隔离通知的遵守率很高，但明显低于未收到通知时报告的预期遵守率。只有五分之一（136/699，19.5%；95%CI 17.0%-22.0%）的参与者了解到，应用程序自动决定发送自我隔离通知。BAME 参与者的看法明显更为负面，包括对 NHS 的信任度较低，而老年人的看法往往更为积极。没有该应用程序的受访者对该应用程序的信任度和看法明显较低，并且不太可能表示他们了解该应用程序的工作原理。
虽然大约 50%拥有该应用程序的参与者的遵守率相当高，但在信任和理解方面存在一些问题，这些问题阻碍了应用程序的采用，从而影响了数字接触追踪的有效性，尤其是在 BAME 社区。本研究强调，需要做更多的工作来提高那些更容易受到病毒影响的群体的采用率，以增强接触者追踪应用程序的采用和接受度。
