JMIR Publications

ABSTRACT

Background:

Contact tracing apps are considered effective means to monitor COVID-19 infections during off-peak stages of the pandemic. The effectiveness is however dependent on the uptake of such COVID-19 apps.

Objective:

We examine the key role of individuals’ general health status in the willingness to participate in a COVID-19 tracing app, as well as the relevance of individuals’ socioeconomic position and ‘COVID-19 proximity.’

Methods:

We draw on survey data from the WageIndicator Foundation: the Living and Working in Coronavirus Times. The survey collects data on one’s labour market status, as well as potential confounders of the relationship between general health and COVID-19 app usage, such as a range of sociodemographics and regular smartphone usage. It also contains information that we use to calculate indicators of COVID-19 proximity such as, having contracted the virus, having observed COVID-19 cases within the family or among colleagues, depressive symptoms, and anxiety. We select data from Spain, Italy, Germany, and the Netherlands between ages 18 and 70 (N = 4,504). Logistic regressions are utilised to measure willingness to use a COVID-19 app.

Results:

We find that the influence of socioeconomic factors on COVID-19 app usage varies dramatically between the 4 countries, although forms of not being employed (i.e. recent job loss and inactivity) is consistently predictive of lower willingness to use a tracing app (24.6%) as compared to (33.4%) for employees (P<.001). Among indicators how close the pandemic comes to one’s nearby social circles (‘COVID-19 proximity’), having a close family member being infected (36.3% vs. 27.1%, P<.001) is consistently predictive of tracing app usage across countries. Accounting for these factors, and the country-variation therein, having a poorer general health status is significantly predictive of a much higher likelihood of contact tracing app usage. That is, compared to a self-reported ‘very good’ health status (predicted probability of 29.6), a ‘good’ (+4.6%-points [1.2–8.1]) and ‘fair or bad’ (+6.3%-points [2.3–10.3]) health statuses yield markedly higher willingness to use a COVID-19 app.

Conclusions:

In so far public health policy is aimed at using smartphone contact tracing during off-peak periods in the pandemic, campaigns appealing to health benefits for oneself and that of family members may be more successful in increasing COVID-19 tracing app uptake. Public health campaigns that rely on digital platforms would also benefit from taking seriously the country-specific distribution of privacy concerns.