Bonnell Tyler Jarvis, Revere Debra, Baseman Janet, Hills Rebecca, Karras Bryant Thomas
Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States.
Department of Health Systems & Population Health, School of Public Health, University of Washington, Seattle, WA, United States.
JMIR Form Res. 2022 Aug 3;6(8):e38193. doi: 10.2196/38193.
In November 2020, WA Notify, Washington State's COVID-19 digital exposure notification tool, was launched statewide to mitigate ongoing COVID-19 transmission. WA Notify uses the Bluetooth proximity-triggered, Google/Apple Exposure Notification Express framework to distribute notifications to users who have added or activated this tool on their smartphones. This smartphone-based tool relies on sufficient population-level activation to be effective; however, little is known about its adoption among communities disproportionately impacted by the COVID-19 pandemic or what barriers might limit its adoption and use among diverse populations.
We sought to (1) conduct a formative exploration of equity-related issues that may influence the access, adoption, and use of WA Notify, as perceived by community leaders of populations disproportionately impacted by the COVID-19 pandemic; and (2) generate recommendations for promoting the equitable access to and impact of this novel intervention for these communities.
We used a 2-step data collection process to gather the perspectives of community leaders across Washington regarding the launch and implementation of WA Notify in their communities. A web-based, brief, and informational survey measured the perceptions of the community-level familiarity and effectiveness of WA Notify at slowing the spread of COVID-19 and identified potential barriers and concerns to accessing and adopting WA Notify (n=17). Semistructured listening sessions were conducted to expand upon survey findings and explore the community-level awareness, barriers, facilitators, and concerns related to activating WA Notify in greater depth (n=13).
Our findings overlap considerably with those from previous mobile health equity studies. Digital literacy, trust, information accessibility, and misinformation were highlighted as key determinants of the adoption and use of WA Notify. Although WA Notify does not track users or share data, community leaders expressed concerns about security, data sharing, and personal privacy, which were cited as outweighing the potential benefits to adoption. Both the survey and informational sessions indicated low community-level awareness of WA Notify. Community leaders recommended the following approaches to improve engagement: tailoring informational materials for low-literacy levels, providing technology navigation, describing more clearly that WA Notify can help the community, and using trusted messengers who are already engaged with the communities to communicate about WA Notify.
As digital public health tools, such as WA Notify, emerge to address public health problems, understanding the key determinants of adoption and incorporating equity-focused recommendations into the development, implementation, and communication efforts around these tools will be instrumental to their adoption, use, and retention.
2020年11月，华盛顿州的新冠疫情数字暴露通知工具WA Notify在全州推出，以减轻新冠疫情的持续传播。WA Notify使用蓝牙近距离触发的谷歌/苹果暴露通知快速框架，向在智能手机上添加或激活此工具的用户发送通知。这个基于智能手机的工具依赖足够的人群层面激活才能有效；然而，对于它在受新冠疫情影响尤为严重的社区中的采用情况，以及哪些障碍可能会限制其在不同人群中的采用和使用，人们知之甚少。
我们试图（1）对可能影响WA Notify的获取、采用和使用的公平性相关问题进行形成性探索，这些问题是受新冠疫情影响尤为严重的人群的社区领袖所感知到的；（2）为促进这些社区公平获取这一新型干预措施并使其产生影响提出建议。
我们采用两步数据收集过程，以收集华盛顿州各地社区领袖对WA Notify在其社区的推出和实施情况的看法。一项基于网络的简短信息调查衡量了社区层面对于WA Notify在减缓新冠疫情传播方面的熟悉程度和有效性的看法，并确定了获取和采用WA Notify的潜在障碍和担忧（n = 17）。开展了半结构化倾听会议，以扩展调查结果，并更深入地探讨与激活WA Notify相关的社区层面的意识、障碍、促进因素和担忧（n = 13）。
我们的研究结果与之前的移动健康公平性研究结果有很大重叠。数字素养、信任、信息可及性和错误信息被突出为采用和使用WA Notify的关键决定因素。尽管WA Notify不跟踪用户或共享数据，但社区领袖表达了对安全、数据共享和个人隐私的担忧，这些被认为超过了采用它可能带来的好处。调查和信息会议都表明社区层面对WA Notify的知晓度较低。社区领袖推荐了以下提高参与度的方法：为低识字水平人群量身定制信息材料、提供技术指导、更清楚地说明WA Notify可以帮助社区，以及利用已经与社区有联系的可靠信使来传达有关WA Notify的信息。
随着诸如WA Notify这样的数字公共卫生工具出现以解决公共卫生问题，了解采用的关键决定因素并将以公平为重点的建议纳入围绕这些工具的开发、实施和宣传工作中，将有助于它们的采用、使用和持续使用。
