The emergence of new variants of COVID-19 causing breakthrough infections and the endemic potential of the coronavirus are an indication that digital contact tracing apps (CTAs) may continue to be useful for the long haul. However, the uptake of these apps in many countries around the world has been low due to several factors militating against their adoption and usage.
In this systematic review, we set out to uncover the key factors that facilitate or militate against the adoption of CTAs, which researchers, designers and other stakeholders should focus on in future iterations to increase their adoption and effectiveness in curbing the spread of COVID-19.
Seven databases, including PubMed, CINAHL, Scopus, Web of Service, IEEE Xplore, ACM Digital Library, and Google Scholar, were searched between October 30 and January 31, 2020. A total of 777 articles were retrieved from the databases, with 13 of them included in the systematic review after screening.
The criteria for including articles in the systematic review were that they could be user studies from any country around the world, must be peer-reviewed, written in English, and focused on the perception and adoption of COVID-19 contact tracing and/or exposure notification apps. Other criteria included user study design could be quantitative, qualitative, or mixed, and must have been conducted during the COVID-19 pandemic, which began in the early part of 2020.
Three researchers searched seven databases (three by the first author, and two each by the second and third authors) and stored the retrieved articles in a collaborative Mendeley reference management system online. After the removal of duplicates, each researcher independently screened one third of the articles based on title/abstract. Thereafter, all three researchers collectively screened articles that were in the borderline prior to undergoing a full-text review. Then, each of the three researchers conducted a full-text review of one-third of the eligible articles to decide the final articles to be included in the systematic review. Next, all three researchers went through the full text of each borderline article to determine their appropriateness and relevance. Finally, each researcher extracted the required data from one-third of the included articles into a collaborative Google spreadsheet and the first author utilized the data to write the review.
This review identified 13 relevant articles, which found 56 factors that may positively or negatively impact the adoption of CTAs. The identified factors were thematically grouped into ten categories: privacy and trust, app utility, facilitating conditions, social-cognitive factors, ethical concerns, perceived technology threats, perceived health threats, technology familiarity, persuasive design, and socio-demographic factors. Of the 56 factors, privacy concern turned out to be the most frequent factor of CTA adoption (12/13), followed by perceived benefit (7/13), perceived trust (6/13), and perceived data security risk (6/13). In the structural equation models presented by the authors of the included articles, a subset of the 56 elicited factors (e.g., perceived benefit and privacy concern) explains 16 to 77% of the variance of users' intention to download, install, or use CTAs to curb the spread of COVID-19. Potential adoption rates of CTA range from 19% (in Australia) to 75% (in France, Italy, Germany, United Kingdom, and United States). Moreover, actual adoption rates range from 37% (in Australia) to 50% (in Germany). Finally, most of the studies were carried out in Europe (66.7%), followed by North America (13.3%), and Australia, Asia, and South America (6.7% each).
The results suggest that future CTA iterations should give priority to privacy protection through minimal data collection and transparency, improving contact tracing benefits (personal and social), and fostering trust through laudable gestures such as delegating contact tracing to public health authorities, making source code publicly available and stating who will access user data, when, how, and what it will be used for. Moreover, the results suggest that data security and tailored persuasive design, involving reward, self-monitoring, and social-location monitoring features, have the potential of improving CTA adoption. Hence, in addition to addressing issues relating to utility, privacy, trust, and data security, we recommend the integration of persuasive features into future designs of CTAs to improve their motivational appeal, adoption, and the user experience.