JMIR Publications

ABSTRACT

Background:

Given the magnitude and speed of SARS-CoV-2 transmission, public health systems worldwide were unable to perform manual contact tracing in a timely and effective manner. Contact tracing apps have been met with significant enthusiasm regarding their potential for automation and reduction of transmission rates, while enabling targeted reconfinement strategies. However, while surveys demonstrate public interest in utilizing such apps, their actual uptake remains limited. Their social acceptability is challenged by questions on privacy, fairness and effectiveness, among other concerns.

Objective:

This review examined the extent to which design and implementation considerations of contact tracing apps are detailed in the available literature, focusing on elements related to participatory and responsible eHealth innovation. We make a series of recommendations to support the development of successful COVID-19 contact tracing apps and related eHealth technologies.

Methods:

Searches were performed on five databases and articles were selected based on eligibility criteria. Papers pertaining to the design, implementation and/or acceptability of contact tracing apps were included. Articles published since 2019, written in English or French and to which full articles were available were considered eligible for analysis. To assess the breadth of elements found in the current literature, we used three complementary frameworks: (1) the Holistic Framework to Improve the Uptake and Impact of eHealth Technologies, (2) the Montreal Model and (3) the Responsible Innovation in Health (RIH) Assessment Tool.

Results:

A total of 63 articles qualified for final analysis. Less than half of the selected articles cited the need for a participatory process (40%), nonetheless constituting the most frequently referenced item of the Framework to Improve the Uptake and Impact of eHealth Technologies. In regard to the Montreal model, stakeholder consultation was the most frequently described level of engagement in the development of contact tracing apps (38%), while collaboration and partnership were cited the least (3%). As for the RIH framework, population health (100%) was addressed in all articles, whereas only 2% covered environmental considerations.

Conclusions:

Most studies lacked key components of eHealth development and implementation. Results demonstrate that stakeholders of COVID-19 contact tracing apps lack important information to critically appraise this eHealth innovation and may have contributed to the modest uptake of contact tracing apps. We recommend a participatory approach in the co-creation and implementation of such e-Health tools, in addition to comprehensive reporting, observational evidence and incentives for utilization.