Study Shows Trust is still at Heart of NHS COVID App Reluctance

A new study has shown that issues surrounding trust are still at the heart of people's reluctance to download and use the NHS App, particularly among Black, Asian and minority ethnic (BAME) communities.

Researchers from the University of Nottingham's Horizon Digital Research Institute and the Trustworthy Autonomous Systems (TAS) Hub undertook a survey of over 1,000 people and found that 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. Their findings have been published in the Journal of Medical Internet Research.

The study involved a nationally representative sample of 16-75 year olds across the UK and took place in December 2020, around 3 months after the app was released.

Results showed that those who chose not to use the app had lower levels of trust, more negative views and less understanding of the app. BAME participants had particularly negative views and were more likely to delete the app. These views include lower trust in the NHS.

Older adults, who are also likely to be more seriously affected by the virus, had more positive views but were also less likely to download the app in the first place. The study also showed that although the intention to follow advice to self-isolate was high, compliance among those who had actually been notified by the app was lower.

Dr Liz Dowthwaite led the study and explains: "This study has revealed a number of issues around trust and compliance, in particular around being notified to self-isolate. Whilst we did not delve into the reasons for this, it may have something to do with the impersonal nature of the app - participants told us they felt it was important that they could verify and get explanations for notifications, as well as that they could speak to a person about what the app told them."

Among the 27.4% of participants who did not intend to download the app, the most common reasons were a desire not to be tracked, not thinking it would be effective, not wanting to take part in contact tracing in that way, and lack of trust in those who built the app. Of the 8.4% who had decided to delete the app, this was mostly because they did not think it was effective or did not want to be tracked.

Liz added: "The findings have implications for the future use of mobile applications for public health; in order to be effective such apps need to be accepted and used by the vast majority of society, and we have seen from this study that there are particular issues in uptake among those most likely to be negatively affected. We believe that It is extremely important to engage the potential users of such technologies at the design stages of these technologies, to identify barriers to use before they are released, in order to enhance uptake."

Dowthwaite L, Fischer J, Perez Vallejos E, Portillo V, Nichele E, Goulden M, McAuley D.
Public Adoption of and Trust in the NHS COVID-19 Contact Tracing App in the United Kingdom: Quantitative Online Survey Study.
J Med Internet Res 2021;23(9):e29085. doi: 10.2196/29085

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