Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Apr 25, 2022
Date Accepted: Oct 13, 2022
Date Submitted to PubMed: Oct 14, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Resident Willingness to Participate in Digital Contact Tracing in a COVID-19 Hotspot: Findings from a Detroit Panel Study
ABSTRACT
Background:
Digital surveillance tools and health informatics show promise in counteracting disease but have limited uptake. A notable illustration of the limits of such tools is the general failure of digital contact tracing in the United States in response to COVID-19.
Objective:
In this paper, we investigate associations between individual characteristics and willingness to use app-based contact tracing in Detroit, a majority-minority city that experienced multiple waves of COVID-19 outbreaks and deaths since the start of the pandemic. The aim of this study was to examine variation among residents in their willingness to download a contact tracing application to their phones to provide public health officials with information about close COVID contact during summer 2020.
Methods:
To examine residents’ willingness to digitally contact trace, we analyzed data from two waves of the Detroit Metro Area Communities Study, a population-based survey of Detroit, Michigan residents. The data capture 1,873 responses from 991 Detroit residents collected in June and July 2020. We estimate a series of multilevel logit models to gain insight into differences in willingness across a variety of individual attributes, including race/ethnicity, degree of trust in government, level of education, and interactions among these variables.
Results:
Our results reflect widespread reluctance to digitally contact trace in response to COVID-19. Compared to White Detroiters, Blacks (OR 0.45, 95% CI 0.23-0.86) and Latinos (OR 0.32, 95% CI 0.11-0.99) were significantly less willing to participate in digital contact tracing. Trust in government was positively associated with willingness to digitally contact trace (OR 1.17, 95% CI 1.07-1.27), but this was truest for White residents (OR 2.14, 95% CI 1.55-2.93). We found similarly divergent patterns of the effects of education by race. Whereas there were no significant differences among non-college-educated residents, White college-educated residents showed greater willingness to use app-based contact tracing (OR 6.12 95% CI 1.86-20.15) while Black college-educated residents showed less willingness (OR .46 95% CI 0.26-0.81).
Conclusions:
Government trust and education contribute to Detroit residents’ wariness of digital contact tracing, reflecting concerns about surveillance that cut across race but likely arise from different sources. These findings point to the importance of culturally informed understandings of health hesitancy for future efforts hoping to leverage digital contact tracing. Though contact tracing technologies have the potential to advance public health, unequal uptake may exacerbate disparate impacts of health crises.