Challenges for Nontechnical Implementation of Digital Proximity Tracing During the COVID-19 Pandemic: Media Analysis of the SwissCovid App
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Abstract
Several countries have released digital proximity tracing (DPT) apps to complement manual contact tracing for combatting the SARS-CoV-2 pandemic. DPT aims to notify app users about proximity exposures to persons infected with SARS-CoV-2 so that they can self-quarantine. The success of DPT apps depends on user acceptance and the embedding of DPT into the pandemic mitigation strategy.
Objective
By searching for media articles published during the first 3 months after DPT launch, the implementation of DPT in Switzerland was evaluated to inform similar undertakings in other countries. The second aim of the study was to create a link between reported DPT implementation challenges and normalization process theory for planning and optimizing complex digital health interventions, which can provide useful guidance for decision-making in DPT design and implementation.
Methods
A Swiss media database was searched for articles on the Swiss DPT app (SwissCovid) published in German or French between July 4 and October 3, 2020. In a structured process, topics were extracted and clustered manually from articles that were deemed pertinent. Extracted topics were mapped to four NPT constructs, which reflected the flow of intervention development from planning, stakeholder onboarding, and execution to critical appraisal. Coherence constructs describe sense-making by stakeholders, cognitive participation constructs reflect participants’ efforts to create engagement with the intervention, collective actions refer to intervention execution and joint stakeholder efforts to make the intervention work, and reflexive monitoring refers to collective risk-benefit appraisals to create improvements.
Results
Out of 94 articles deemed pertinent and selected for closer inspection, 38 provided unique information on implementation challenges. Five challenge areas were identified: communication challenges, challenges for DPT to interface with other processes, fear of resource competition with established pandemic mitigation measures, unclear DPT effectiveness, and obstacles to greater user coverage and compliance. Specifically, several articles mentioned unclear DPT benefits to affect commitment and to raise fears among different health system actors regarding resource competition. Moreover, media reports indicated process interface challenges such as delays or unclear responsibilities in the notification cascade, as well as misunderstandings and unmet communication needs from health system actors. Finally, reports suggested misaligned incentives, not only for app usage by the public but also for process engagement by other actors in the app notification cascade. NPT provided a well-fitting framework to contextualize the different DPT implementation challenges and to highlight improvement strategies, namely a better alignment of stakeholder incentives, or stakeholder-specific communication to address their concerns about DPT.
Conclusions
Early experiences from one of the first adopters of DPT indicate that nontechnical implementation challenges may affect the effectiveness of DPT. The NPT analysis provides a novel perspective on DPT implementation and stresses the need for stakeholder inclusion in development and operationalization.
Article activity feed
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SciScore for 10.1101/2020.10.22.20218057: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Some limitations of the study and its interpretation are worth noting. The reliance on published media reports (and not, for example, on stakeholder interviews) may have limited the diversity and level of detail of the current debates about DPT. It may also have missed aspects that were never raised by the media but discussed …
SciScore for 10.1101/2020.10.22.20218057: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Some limitations of the study and its interpretation are worth noting. The reliance on published media reports (and not, for example, on stakeholder interviews) may have limited the diversity and level of detail of the current debates about DPT. It may also have missed aspects that were never raised by the media but discussed bilaterally between different actors.The reliance on published media report was an advantage as it enhanced the reproducibility of our study. Furthermore, it should be noted that the challenges outlined in this report do not reflect the status quo situation, and it is not intended to pass judgment on the success of DPT or the roles of the different participants in Switzerland. To summarize, the analysis of media reports on implementation challenges for DPT in Switzerland demonstrates that the non-technical implementation of DPT must not be forgotten. The experiences in Switzerland indicate that the technical aspects work well, but in some instances, the non-technical processes led to bottlenecks in the notification chain. This is understandable given the multiple interactions required between different participants. The lessons from Switzerland, one of the earliest adopters of DPT, and the demonstration of the usefulness of NPT for planning and analyzing NPT implementation may hopefully serve as an inspiration for other countries developing their own DPT implementation.
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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