JMIR Publications

ABSTRACT

Background:

Several countries have released digital proximity tracing (DPT) apps in addition to manual contact tracing (MCT) to combat the Sars-CoV-2 pandemic. The goal of DPT is 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 DPT embedding into the pandemic mitigation strategy.

Objective:

Using media articles published during the first three months after DPT app launch, the implementation in Switzerland, so that other countries can benefit from the experiences of one of the earliest DPT adopters. Th second aim was to create a link between reported DPT implementation challenges with normalization process theory (NPT) for planning and optimizing complex digital health interventions, which can provide useful guidance for decision-making of 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 04.07.2020 and 03.10.2020. Topics were extracted and clustered manually from articles that were deemed pertinent in a structured process. Extracted topics were mapped to NPT constructs.

Results:

Out of 94 articles deemed pertinent and selected for closer inspection, 38 provided unique information on implementation challenges. These challenges included unclear DPT benefits, which affected commitment and raised fears among different health system actors regarding resource competition with established pandemic mitigation measures. 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 certain health system actors. Finally, some 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. These challenges mapped well to the four constructs of NPT, thus providing a framework to contextualize the different DPT implementation challenges and to highlight improvement strategies.

Conclusions:

Early experiences from one of the first adopters of DPT indicate that non-technical implementation challenges warrant attention. The detected implementation challenges fit well into the framework of NPT, which seems suited to guide the development and evaluation of complex DPT interventions.