Belief of having had unconfirmed Covid-19 infection reduces willingness to participate in app-based contact tracing
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Abstract
Contact tracing and lockdown are health policies being used worldwide to combat the coronavirus (COVID-19). The UK National Health Service (NHS) Track and Trace Service has plans for a nationwide app that notifies the need for self-isolation to those in contact with a person testing positive for COVID-19. To be successful, such an app will require high uptake, the determinants and willingness for which are unclear but essential to understand for effective public health benefit. The objective of this study was to measure the determinants of willingness to participate in an NHS app-based contact-tracing programme using a questionnaire within the Care Information Exchange (CIE)—the largest patient-facing electronic health record in the NHS. Among 47,708 registered NHS users of the CIE, 27% completed a questionnaire asking about willingness to participate in app-based contact tracing, understanding of government advice, mental and physical wellbeing and their healthcare utilisation—related or not to COVID-19. Descriptive statistics are reported alongside univariate and multivariable logistic regression models, with positive or negative responses to a question on app-based contact tracing as the dependent variable. 26.1% of all CIE participants were included in the analysis ( N = 12,434, 43.0% male, mean age 55.2). 60.3% of respondents were willing to participate in app-based contact tracing. Out of those who responded ‘no’, 67.2% stated that this was due to privacy concerns. In univariate analysis, worsening mood, fear and anxiety in relation to changes in government rules around lockdown were associated with lower willingness to participate. Multivariable analysis showed that difficulty understanding government rules was associated with a decreased inclination to download the app, with those scoring 1–2 and 3–4 in their understanding of the new government rules being 45% and 27% less inclined to download the contact-tracing app, respectively; when compared to those who rated their understanding as 5–6/10 (OR for 1–2/10 = 0.57 [CI 0.48–0.67]; OR for 3–4/10 = 0.744 [CI 0.64–0.87]), whereas scores of 7–8 and 9–10 showed a 43% and 31% respective increase. Those reporting an unconfirmed belief of having previously had and recovered from COVID-19 were 27% less likely to be willing to download the app; belief of previous recovery from COVID-19 infection OR 0.727 [0.585–0.908]). In this large UK-wide questionnaire of wellbeing in lockdown, a willingness for app-based contact tracing over an appropriate age range is 60%—close to the estimated 56% population uptake, and substantially less than the smartphone-user uptake considered necessary for an app-based contact tracing to be an effective intervention to help suppress an epidemic. Difficulty comprehending government advice and uncertainty of diagnosis, based on a public health policy of not testing to confirm self-reported COVID-19 infection during lockdown, therefore reduce willingness to adopt a government contact-tracing app to a level below the threshold for effectiveness as a tool to suppress an epidemic.
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SciScore for 10.1101/2020.06.03.20120337: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: The full questionnaire is included in appendix A. Data and Consent: The CIE, including the questionnaire, is a tool for direct care at Imperial College Healthcare NHS Trust, therefore formal consent for data analysis and ethical approval was not required. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Study Participants: Participants in this study were individuals with a previous healthcare event or encounter e.g. hospital admission, outpatient appointment, medical investigation at a London-based tertiary NHS Trust (Imperial … SciScore for 10.1101/2020.06.03.20120337: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: The full questionnaire is included in appendix A. Data and Consent: The CIE, including the questionnaire, is a tool for direct care at Imperial College Healthcare NHS Trust, therefore formal consent for data analysis and ethical approval was not required. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Study Participants: Participants in this study were individuals with a previous healthcare event or encounter e.g. hospital admission, outpatient appointment, medical investigation at a London-based tertiary NHS Trust (Imperial College Healthcare NHS Foundation Trust). College Healthcaresuggested: NoneTiming of Questionnaire: The questionnaire was sent out on Friday 15th May 2020, five days after the UK government changed its messaging around lockdown from ‘Stay Home, Protect the NHS, Save Lives’ to ‘Stay Alert, Control the Virus, Save Lives’, accompanied by the easing of some lockdown restrictions. Protectsuggested: (ProTECT, RRID:SCR_004531)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:There are several limitations to this study. These results are only indicative; whether participants stick to their response when faced with wide release and accompanying messaging from the government to download the app is uncertain. However, previous studies have shown good correlation between declared survey responses and subsequent behaviour.27-29 Twenty-two percent of respondents were ‘not sure’ about their willingness, but this response was not further qualified to identify underlying reasons. Patients registered on the CIE without internet, who could not log in to their CIE account, or were incapable of understanding or responding will be underrepresented, though such potential biases will have been mitigated by the large sample size. This study will by default have included many ‘shielded’ patients, identified and advised by the NHS to stay at home at all times due to their disease profile placing them at higher risk of adverse outcomes from COVID-19,16 for whom attitudes to participation in app based contact tracing will have its own considerations but are no less important. Conclusion: Poor understanding of government rules around lockdown and belief of having had COVID-19 decrease willingness to participate in app-based contact tracing. Using the largest patient-facing EHR in the NHS as an effective and timely questionnaire tool, we have revealed the role of uncertainties in both government messaging and not testing suspected COVID-19 infection in reducing willingn...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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