%0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e57191 %T Promoting Hand Hygiene During the COVID-19 Pandemic: Randomized Controlled Trial of the Optimized Soapp+ App %A Baretta,Dario %A Rüttimann,Carole Lynn %A Amrein,Melanie Alexandra %A Inauen,Jennifer %+ Institute of Psychology, University of Bern, Fabrikstarsse 8, Bern, 3012, Switzerland, 41 31 684 81 11, dario.baretta@unibe.ch %K COVID-19 %K hand hygiene %K behavior change technique %K Multiphase Optimization Strategy %K randomized controlled trial %K smartphone apps %K mobile phones %D 2025 %7 24.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The adoption of protective behaviors represents a crucial measure to counter the spread of infectious diseases. The development of effective behavior change techniques therefore emerged as a public health priority during the COVID-19 pandemic, but randomized controlled trials (RCTs) testing such interventions during the pandemic were scarce. We conducted a Multiphase Optimization Strategy to develop, optimize, and evaluate a smartphone app, Soapp+, to promote hand hygiene during the COVID-19 pandemic. Objective: This RCT aims to evaluate the efficacy of the Soapp+ app (intervention group) targeting motivation and habit compared to a simplified version of the app mainly delivering hand hygiene information (active control group). We hypothesize that, compared to the control group, the intervention group will show greater improvements in hand hygiene behavior and behavioral determinants post intervention and at a 6-month follow-up. Methods: We conducted an RCT from March 2022 to April 2023, recruiting 193 adults living in Switzerland online. Following baseline assessment, the intervention lasted 32 days, followed by a postintervention assessment and a 6-month follow-up. The primary outcome was the change in hand hygiene behavior from pre- to postintervention and preintervention to follow-up. Hand hygiene was assessed with electronic diaries. The intervention group received content incorporating various behavior change techniques designed to address key motivational and volitional determinants of hand hygiene behavior (eg, skills, knowledge, intention, attitudes toward hand hygiene, risk perception, outcome expectancies, self-efficacy, action planning, coping planning, action control, habit). In contrast, the active control group was exposed to behavior change techniques targeting only a subset of these determinants (ie, skills, knowledge, and intention). The delivery of the intervention content was fully automated. Group differences were tested using an intention-to-treat approach with the nonparametric Wilcoxon rank sum test. Results: Of the 193 randomized participants, 146 completed the first hand hygiene diary preintervention and were included in the main analysis. The mean age was 41 (SD 17) years, and 69.2% (n=101) were women. The main analysis revealed significant superiority of the intervention compared to controls in the change in hand hygiene pre-post intervention (W=2034; P<.04; effect size r=0.17) and between preintervention and follow-up (W=2005; P<.03; effect size r=0.18). Regarding behavioral determinants, the change in coping planning pre-post intervention (W=3840; P=.03, effect size r=0.16) was significantly greater in the intervention group using Soapp+ compared to controls. Conclusions: Soapp+ was developed through a rigorous experimental method during the ongoing COVID-19 pandemic. The RCT provided evidence for the efficacy of Soapp+ to promote hand hygiene in the context of a pandemic. Trial Registration: ClinicalTrials.gov NCT04830761; https://clinicaltrials.gov/study/NCT04830761 %M 40273441 %R 10.2196/57191 %U https://mhealth.jmir.org/2025/1/e57191 %U https://doi.org/10.2196/57191 %U http://www.ncbi.nlm.nih.gov/pubmed/40273441 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e53339 %T Application of an Innovative Methodology to Build Infrastructure for Digital Transformation of Health Systems: Developmental Program Evaluation %A Buchan,M Claire %A Katapally,Tarun Reddy %A Bhawra,Jasmin %+ CHANGE Research Lab, School of Occupational and Public Health, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON, M5B2K3, Canada, 1 416 979 5000 ext 553466, jasmin.bhawra@torontomu.ca %K digital health platform %K citizen science %K evaluation %K health systems %K digital health %K app %K innovative %K digital transformation %K public health %K crises %K communicable disease %K coronavirus %K chronic diseases %K decision-making %K assessment %K thematic analysis %K self-report survey %K risk %K artificial intelligence %K AI %D 2025 %7 17.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The current public health crises we face, including communicable disease pandemics such as COVID-19, require cohesive societal efforts to address decision-making gaps in our health systems. Digital health platforms that leverage big data ethically from citizens can transform health systems by enabling real-time data collection, communication, and rapid responses. However, the lack of standardized and evidence-based methods to develop and implement digital health platforms currently limits their application. Objective: This study aims to apply mixed evaluation methods to assess the development of a rapid response COVID-19 digital health platform before public launch by engaging with the development and research team, which consists of interdisciplinary researchers (ie, key stakeholders). Methods: Using a developmental evaluation approach, this study conducted (1) a qualitative survey assessing digital health platform objectives, modifications, and challenges administered to 5 key members of the software development team and (2) a role-play pilot with 7 key stakeholders who simulated 8 real-world users, followed by a self-report survey, to evaluate the utility of the digital health platform for each of its objectives. Survey data were analyzed using an inductive thematic analysis approach. Postpilot test survey data were aggregated and synthesized by participant role. Results: The digital health platform met original objectives and was expanded to accommodate the evolving needs of potential users and COVID-19 pandemic regulations. Key challenges noted by the development team included navigating changing government policies and supporting the data sovereignty of platform users. Strong team cohesion and problem-solving were essential in the overall success of program development. During the pilot test, participants reported positive experiences interacting with the platform and found its features relatively easy to use. Users in the community member role felt that the platform accurately reflected their risk of contracting COVID-19, but reported some challenges interacting with the interface. Those in the decision maker role found the data visualizations helpful for understanding complex information. Both participant groups highlighted the utility of a tutorial for future users. Conclusions: Evaluation of the digital health platform development process informed our decisions to integrate the research team more cohesively with the development team, a practice that is currently uncommon given the use of external technology vendors in health research. In the short term, the developmental evaluation resulted in shorter sprints, and the role-play exercise enabled improvements to the log-in process and user interface ahead of public deployment. In the long term, this exercise informed the decision to include a data scientist as part of both teams going forward to liaise with researchers throughout the development process. More interdisciplinarity was also integrated into the research process by providing health system training to computer programmers, a key factor in human-centered artificial intelligence development. %M 40245398 %R 10.2196/53339 %U https://formative.jmir.org/2025/1/e53339 %U https://doi.org/10.2196/53339 %U http://www.ncbi.nlm.nih.gov/pubmed/40245398 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60461 %T Acceptability, User Satisfaction, and Feasibility of an App-Based Support Service During the COVID-19 Pandemic in a Psychiatric Outpatient Setting: Prospective Longitudinal Observational Study %A Golsong,Konstanze %A Kaufmann,Luisa %A Baldofski,Sabrina %A Kohls,Elisabeth %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Haus 13, Semmelweisstraße 10, Leipzig, Germany, 49 341 9724464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K mental health %K eHealth %K app %K health care %K app-based support %K psychiatric symptoms %K mobile phone %K COVID-19 %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with mental disorders often have difficulties maintaining a daily routine, which can lead to exacerbated symptoms. It is known that apps can help manage mental health in a low-threshold way and can be used in therapeutic settings to complement existing therapies. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of an app-based support service specifically developed for outpatients with severe mental disorders in addition to regular face-to-face therapy during the COVID-19 pandemic. Methods: Patients in a psychiatric outpatient department at a German university hospital were invited to use an app-based support service designed transdiagnostically for mental disorders for 4 weeks. The app included 7 relaxation modules, consisting of video, audio, and psychoeducational text; ecological momentary assessment–like questionnaires on daily mood answered via a visual smiley-face scale; and an activity button to record and encourage daily activities. Standardized questionnaires at baseline (T0; preintervention time point) and after 4 weeks (T2; postintervention time point) were analyzed. Feedback via the smiley-face scale was provided after using the app components (T1; during the intervention). Measures included depressive symptoms, quality of life, treatment credibility and expectancy, and satisfaction. Furthermore, participation rates, use of app modules and the activity button, and daily mood and the provided feedback were analyzed (T2). Results: In total, 57 patients participated in the study, and the data of 38 (67%) were analyzed; 17 (30%) dropped out. Satisfaction with the app was high, with 53% (30/57) of the participants stating being rather satisfied or satisfied. Furthermore, 79% (30/38) of completers stated they would be more likely or were definitely likely to use an app-based support service again and recommend it. Feasibility and acceptability were high, with nearly half (18/38, 47%) of the completers trying relaxation modules and 71% (27/38) regularly responding to the ecological momentary assessment–like questionnaire between 15 and 28 times (mean 19.91, SD 7.57 times). The activity button was used on average 12 (SD 15.72) times per completer, and 58% (22/38) felt “definitely” or “rather” encouraged to perform the corresponding activities. Depressive symptomatology improved significantly at the postintervention time point (P=.02). Quality of life showed a nonsignificant increase in the physical, psychological, and social domains (P=.59, P=.06, and P=.42, respectively) and a significant improvement in the environment domain (P=.004). Treatment credibility and expectancy scores were moderate and significantly decreased at T2 (P=.02 and P<.001, respectively). Posttreatment expectancy scores were negatively associated with posttreatment depressive symptomatology (r=–0.36; P=.03). Conclusions: App-based programs seem to be an accessible tool for stabilizing patients with severe mental disorders, supporting them in maintaining a daily routine, complementing existing face-to-face treatments, and overall helping respond to challenging situations such as the COVID-19 pandemic. %M 39630503 %R 10.2196/60461 %U https://formative.jmir.org/2024/1/e60461 %U https://doi.org/10.2196/60461 %U http://www.ncbi.nlm.nih.gov/pubmed/39630503 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50184 %T Mobile Phone Syndromic Surveillance for Respiratory Conditions in an Emergency (COVID-19) Context in Colombia: Representative Survey Design %A Vecino-Ortiz,Andres I %A Guzman-Tordecilla,Deivis Nicolas %A Maniar,Vidhi %A Agudelo-Londoño,Sandra %A Franco-Suarez,Oscar %A Aya Pastrana,Nathaly %A Rodríguez-Patarroyo,Mariana %A Mejía-Rocha,Marino %A Cardona,Jaime %A Chavez Chamorro,Mariangela %A Gibson,Dustin %+ Health Systems Program, International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, United States, 1 410 955 3934, andres.vecino@gmail.com %K mobile phone surveys %K syndromic surveillance %K COVID-19 %K public health surveillance %K IVR %K interactive voice response %K survey %K surveys %K voice response %K syndromic %K surveillance %K respiratory %K pandemic %K SARS-CoV-2 %K feasibility %K data collection %K public health %K emergency %K outbreak %K mobile phone %D 2024 %7 17.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Syndromic surveillance for respiratory infections such as COVID-19 is a crucial part of the public health surveillance toolkit as it allows decision makers to detect and prepare for new waves of the disease in advance. However, it is labor-intensive, costly, and increases exposure to survey personnel. This study assesses the feasibility of conducting a mobile phone–based respiratory syndromic surveillance program in a middle-income country during a public health emergency, providing data to support the inclusion of this method in the standard infection control protocols at the population level. Objective: This study aims to assess the feasibility of a national active syndromic surveillance system for COVID-19 disease in Colombia. Methods: In total, 2 pilots of syndromic mobile phone surveys (MPSs) were deployed using interactive voice response technology in Colombia (367 complete surveys in March 2022 and 451 complete surveys in April and May 2022). Respondents aged 18 years and older were sampled using random digit dialing, and after obtaining consent, they were sent a 10-minute survey with modules on sociodemographic status, respiratory symptoms, past exposure to COVID-19 infection and vaccination status, preferences about COVID-19 vaccination, and information source for COVID-19. Pilot 1 used a nationally representative sample while pilot 2 used quota sampling to yield representative results at the regional level. In this work, we assessed the performance characteristics of the survey pilots and compared the demographic information collected with a nationally representative household survey. Results: For both pilots, contact rates were between 1% and 2%, while participation rates were above 80%. The results revealed that younger, female, and higher educated participants were more likely to participate in the syndromic survey. Survey rates as well as demographics, COVID-19 vaccination status, and prevalence of respiratory symptoms are reported for both pilots. We found that respondents of the MPSs are more likely to be younger and female. Conclusions: In a COVID-19 pandemic setting, using an interactive voice response MPS to conduct syndromic surveillance may be a transformational, low-risk, and feasible method to detect outbreaks. This evaluation expects to provide a path forward to the inclusion of MPSs as a traditional surveillance method. %M 39418077 %R 10.2196/50184 %U https://www.jmir.org/2024/1/e50184 %U https://doi.org/10.2196/50184 %U http://www.ncbi.nlm.nih.gov/pubmed/39418077 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50745 %T Feasibility, Acceptability, Satisfaction, and Challenges of an mHealth App (e-ASCov) for Community-Based COVID-19 Screening by Community Health Workers in Rwanda: Mixed Methods Study %A Omorou,Abdou Y %A Ndishimye,Pacifique %A Hoen,Bruno %A Mutesa,Léon %A Karame,Prosper %A Nshimiyimana,Ladislas %A Galmiche,Simon %A Mugabo,Hassan %A Murayire,Janvier %A Mugisha,Muco %A Umulisa,Marie Michele %A Uwera,Yvonne Delphine Nsaba %A Musanagabanwa,Clarisse %A Bigirimana,Noella %A Nsanzimana,Sabin %A Guillemin,Francis %A Rwabihama,Jean Paul %K community health workers %K COVID-19 screening tool %K COVID-19 %K SARS-CoV-2 %K screening %K acceptability %K feasibility %K satisfaction %K community based %K LMIC %K Africa %K challenges %K barriers %K smartphone %K proof-of-concept %K mHealth %K mobile health %K apps %K COVID-19 screening %D 2024 %7 14.10.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Although at the base of the pyramid-shaped organization of the Rwandan health system, community health workers (CHWs) are central to the community-based management of disease outbreaks. Objective: This mixed methods study aimed to explore the feasibility, acceptability, satisfaction, and challenges of a mobile health (mHealth) tool for community-based COVID-19 screening in Rwanda. Methods: Two urban (Gasabo and Nyarugenge) and 2 rural (Rusizi and Kirehe) districts in Rwanda participated in the project (smartphone app for COVID-19 screening). A mixed methods approach was used to inform the feasibility (awareness and expectation), acceptability (use and perceived benefits), satisfaction, and challenges of the mHealth intervention. At the end of the project, CHWs were asked to complete a quantitative questionnaire on the use of and satisfaction with the app. Then, in-depth interviews and focus group discussions were organized with CHWs. A content analysis was performed on the transcripts. Results: Overall, 383 CHWs were recruited and trained; 378 CHWs participated in the study. The mean age of CHWs was 36.7 (SD 6.6) to 45.3 (SD 9.9) years and most were women (237/378, 62.7%). More than 7000 people were registered with the use of the app and 20% were referred to a local COVID-19 testing facility. According to CHW reporting, the median number of people screened by each CHW ranged from 152 (IQR 70-276) for Nyarugenge to 24 (IQR 16-90) for Rusizi. COVID-19 positivity rates were higher in urban than rural districts: more than half of the CHWs in Gasabo reported a confirmed positive case versus only 2.4% for Kirehe and 15.4% for Rusizi. Despite the app being a novel tool, CHWs were well aware of the use of such a tool and had appropriate expectations. Acceptability and satisfaction were very high, with differences between urban and rural districts. Satisfaction was higher in Nyarugenge (72.8/100) and Gasabo (80.7/100) than in Kirehe (61.6/100) and Rusizi (64.5/100). More than 80% of the CHWs were willing to continue using the e-ASCov app, with the exception of CHWs in Kirehe (56.7%). The app was perceived as a tool to generate information on COVID-19, inform on the status of the pandemic, and help curb the spread of the pandemic in Rwanda. CHWs were satisfied with the app at all stages of its implementation in their districts. Conclusions: In this proof-of-concept study, a smartphone app for screening COVID-19 was useful as an mHealth tool to be used by CHWs, with the potential to increase health system efficiency in an epidemic context. The context should be analyzed for generalization on a country-wide scale, both in case of an epidemic and to take into account certain conditions at the community level. Information is needed on the conditions of generalization and transferability of this type of app to other health conditions so that CHWs can be given their full place in a pyramidal health system. %R 10.2196/50745 %U https://mhealth.jmir.org/2024/1/e50745 %U https://doi.org/10.2196/50745 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57309 %T Contextual Acceptance of COVID-19 Mitigation Mobile Apps in the United States: Mixed Methods Survey Study on Postpandemic Data Privacy %A Feng,Yuanyuan %A Stenger,Brad %A Zhang,Shikun %+ Department of Computer Science, University of Vermont, 85 South Prospect Street, Burlington, VT, 05405, United States, 1 802 656 3475, yuanyuan.feng@uvm.edu %K data privacy %K health privacy %K COVID-19 %K mobile apps %K contextual integrity %K respiratory %K infectious %K pulmonary %K pandemic %K mobile app %K app %K apps %K digital health %K digital technology %K digital intervention %K digital interventions %K smartphone %K smartphones %K mobile phone %D 2024 %7 29.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic gave rise to countless user-facing mobile apps to help fight the pandemic (“COVID-19 mitigation apps”). These apps have been at the center of data privacy discussions because they collect, use, and even retain sensitive personal data from their users (eg, medical records and location data). The US government ended its COVID-19 emergency declaration in May 2023, marking a unique time to comprehensively investigate how data privacy impacted people’s acceptance of various COVID-19 mitigation apps deployed throughout the pandemic. Objective: This research aims to provide insights into health data privacy regarding COVID-19 mitigation apps and policy recommendations for future deployment of public health mobile apps through the lens of data privacy. This research explores people’s contextual acceptance of different types of COVID-19 mitigation apps by applying the privacy framework of contextual integrity. Specifically, this research seeks to identify the factors that impact people’s acceptance of data sharing and data retention practices in various social contexts. Methods: A mixed methods web-based survey study was conducted by recruiting a simple US representative sample (N=674) on Prolific in February 2023. The survey includes a total of 60 vignette scenarios representing realistic social contexts that COVID-19 mitigation apps could be used. Each survey respondent answered questions about their acceptance of 10 randomly selected scenarios. Three contextual integrity parameters (attribute, recipient, and transmission principle) and respondents’ basic demographics are controlled as independent variables. Regression analysis was performed to determine the factors impacting people’s acceptance of initial data sharing and data retention practices via these apps. Qualitative data from the survey were analyzed to support the statistical results. Results: Many contextual integrity parameter values, pairwise combinations of contextual integrity parameter values, and some demographic features of respondents have a significant impact on their acceptance of using COVID-19 mitigation apps in various social contexts. Respondents’ acceptance of data retention practices diverged from their acceptance of initial data sharing practices in some scenarios. Conclusions: This study showed that people’s acceptance of using various COVID-19 mitigation apps depends on specific social contexts, including the type of data (attribute), the recipients of the data (recipient), and the purpose of data use (transmission principle). Such acceptance may differ between the initial data sharing and data retention practices, even in the same context. Study findings generated rich implications for future pandemic mitigation apps and the broader public health mobile apps regarding data privacy and deployment considerations. %M 39207832 %R 10.2196/57309 %U https://www.jmir.org/2024/1/e57309 %U https://doi.org/10.2196/57309 %U http://www.ncbi.nlm.nih.gov/pubmed/39207832 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47070 %T COVID-19 Vaccine Effectiveness and Digital Pandemic Surveillance in Germany (eCOV Study): Web Application–Based Prospective Observational Cohort Study %A Lang,Anna-Lena %A Hohmuth,Nils %A Višković,Vukašin %A Konigorski,Stefan %A Scholz,Stefan %A Balzer,Felix %A Remschmidt,Cornelius %A Leistner,Rasmus %+ d4l Data4Life gGmbH, c/o Digital Health Cluster (DHC) im Hasso-Plattner-Institut, Rudolf-Breitscheid-Straße 187, Potsdam, 14482, Germany, 49 015756025551, annalena.lang.26@gmail.com %K COVID-19 %K SARS-CoV-2 %K COVID-19 vaccines %K BNT162b2 %K vaccine effectiveness %K participatory disease surveillance %K web application %K digital public health %K vaccination %K Germany %K effectiveness %K data collection %K disease surveillance %K tool %D 2024 %7 4.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic posed significant challenges to global health systems. Efficient public health responses required a rapid and secure collection of health data to improve the understanding of SARS-CoV-2 and examine the vaccine effectiveness (VE) and drug safety of the novel COVID-19 vaccines. Objective: This study (COVID-19 study on vaccinated and unvaccinated subjects over 16 years; eCOV study) aims to (1) evaluate the real-world effectiveness of COVID-19 vaccines through a digital participatory surveillance tool and (2) assess the potential of self-reported data for monitoring key parameters of the COVID-19 pandemic in Germany. Methods: Using a digital study web application, we collected self-reported data between May 1, 2021, and August 1, 2022, to assess VE, test positivity rates, COVID-19 incidence rates, and adverse events after COVID-19 vaccination. Our primary outcome measure was the VE of SARS-CoV-2 vaccines against laboratory-confirmed SARS-CoV-2 infection. The secondary outcome measures included VE against hospitalization and across different SARS-CoV-2 variants, adverse events after vaccination, and symptoms during infection. Logistic regression models adjusted for confounders were used to estimate VE 4 to 48 weeks after the primary vaccination series and after third-dose vaccination. Unvaccinated participants were compared with age- and gender-matched participants who had received 2 doses of BNT162b2 (Pfizer-BioNTech) and those who had received 3 doses of BNT162b2 and were not infected before the last vaccination. To assess the potential of self-reported digital data, the data were compared with official data from public health authorities. Results: We enrolled 10,077 participants (aged ≥16 y) who contributed 44,786 tests and 5530 symptoms. In this young, primarily female, and digital-literate cohort, VE against infections of any severity waned from 91.2% (95% CI 70.4%-97.4%) at week 4 to 37.2% (95% CI 23.5%-48.5%) at week 48 after the second dose of BNT162b2. A third dose of BNT162b2 increased VE to 67.6% (95% CI 50.3%-78.8%) after 4 weeks. The low number of reported hospitalizations limited our ability to calculate VE against hospitalization. Adverse events after vaccination were consistent with previously published research. Seven-day incidences and test positivity rates reflected the course of the pandemic in Germany when compared with official numbers from the national infectious disease surveillance system. Conclusions: Our data indicate that COVID-19 vaccinations are safe and effective, and third-dose vaccinations partially restore protection against SARS-CoV-2 infection. The study showcased the successful use of a digital study web application for COVID-19 surveillance and continuous monitoring of VE in Germany, highlighting its potential to accelerate public health decision-making. Addressing biases in digital data collection is vital to ensure the accuracy and reliability of digital solutions as public health tools. %M 38833299 %R 10.2196/47070 %U https://www.jmir.org/2024/1/e47070 %U https://doi.org/10.2196/47070 %U http://www.ncbi.nlm.nih.gov/pubmed/38833299 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50716 %T Use of Digital COVID-19 Exposure Notifications at a Large Gathering: Survey Analysis of Public Health Conference Attendees %A Drover,Caitlin M %A Elder,Adam S %A Guthrie,Brandon L %A Revere,Debra %A Briggs,Nicole L %A West,Laura M %A Higgins,Amanda %A Lober,William B %A Karras,Bryant T %A Baseman,Janet G %+ Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Seattle, WA, 98195-1616, United States, 1 5056159180, eldera3@uw.edu %K COVID-19 %K exposure notification %K digital public health tool %K survey analysis %K conference %K online survey %K digital tool %K public health %K contact tracing %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: WA Notify was Washington State’s smartphone-based COVID-19 digital exposure notification (EN) tool, which was used to help limit the spread of COVID-19 between November 30, 2020, and May 11, 2023. Following the 2022 Washington State Public Health Association Annual Conference, attendees who had WA Notify activated began receiving ENs alerting them to a possible COVID-19 exposure during the conference. A survey was emailed to all conference attendees to measure WA Notify adoption, mechanisms through which attendees received ENs, and self-reported engagement in protective behaviors postexposure. Objective: This study aimed to learn more about the experiences of WA Notify adopters and nonadopters who may have been exposed to COVID-19 at a large group gathering. Methods: A web-based survey administered through REDCap (Research Electronic Data Capture; Vanderbilt University) was sent to all attendees of the Washington State Public Health Association conference. Self-reported demographic information and characteristics of respondents were summarized. Regression models were used to estimate relative risks to compare WA Notify adoption and testing behaviors between groups. Results: Of the 464 total registered attendees who were sent the survey, 205 (44%) responses were received; 201 eligible attendees were included in this analysis. Of those, 149 (74%) respondents reported having WA Notify activated on their phones at the time of the conference. Among respondents with WA Notify activated, 54% (n=77) reported learning of their potential exposure from a WA Notify EN. Respondents who reported that they did not have WA Notify activated and learned of their potential exposure via the event-wide email from conference organizers were 39% less likely to test for COVID-19 compared to respondents with WA Notify activated who learned of their potential exposure from the email (relative risk 0.61, 95% CI 0.40-0.93; P=.02), and this gap was even larger when compared to respondents who learned of their exposure from a WA Notify EN. The most commonly cited reason for not having WA Notify activated was privacy concerns (n=17, 35%), followed by not wanting to receive ENs (n=6, 12%) and being unaware of WA Notify (n=5, 10%). Conclusions: Digital EN systems are an important tool to directly and anonymously notify close contacts of potential exposures and provide guidance on the next steps in a timely manner. Given the privacy concerns, there is still a need for increasing transparency surrounding EN technology to increase uptake by the public if this technology were to be used in the future to slow the spread of communicable diseases. %M 38498047 %R 10.2196/50716 %U https://formative.jmir.org/2024/1/e50716 %U https://doi.org/10.2196/50716 %U http://www.ncbi.nlm.nih.gov/pubmed/38498047 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48986 %T The Roles of Trust in Government and Sense of Community in the COVID-19 Contact Tracing Privacy Calculus: Mixed Method Study Using a 2-Wave Survey and In-Depth Interviews %A Kang,Hyunjin %A Lee,Jeong Kyu %A Lee,Edmund WJ %A Toh,Cindy %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore, 637718, Singapore, 65 69083431, hjkang@ntu.edu.sg %K COVID-19 %K contact tracing technology %K privacy calculus %K trust in government %K sense of community %K mixed method %K mobile phone %D 2024 %7 7.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Contact tracing technology has been adopted in many countries to aid in identifying, evaluating, and handling individuals who have had contact with those infected with COVID-19. Singapore was among the countries that actively implemented the government-led contact tracing program known as TraceTogether. Despite the benefits the contact tracing program could provide to individuals and the community, privacy issues were a significant barrier to individuals’ acceptance of the program. Objective: Building on the privacy calculus model, this study investigates how the perceptions of the 2 key groups (ie, government and community members) involved in the digital contact tracing factor into individuals’ privacy calculus of digital contact tracing. Methods: Using a mixed method approach, we conducted (1) a 2-wave survey (n=674) and (2) in-depth interviews (n=12) with TraceTogether users in Singapore. Using structural equation modeling, this study investigated how trust in the government and the sense of community exhibited by individuals during the early stage of implementation (time 1) predicted privacy concerns, perceived benefits, and future use intentions, measured after the program was fully implemented (time 2). Expanding on the survey results, this study conducted one-on-one interviews to gain in-depth insights into the privacy considerations involved in digital contact tracing. Results: The results from the survey showed that trust in the government increased perceived benefits while decreasing privacy concerns regarding the use of TraceTogether. Furthermore, individuals who felt a connection to community members by participating in the program (ie, the sense of community) were more inclined to believe in its benefits. The sense of community also played a moderating role in the influence of government trust on perceived benefits. Follow-up in-depth interviews highlighted that having a sense of control over information and transparency in the government’s data management were crucial factors in privacy considerations. The interviews also highlighted surveillance as the most prevalent aspect of privacy concerns regarding TraceTogether use. In addition, our findings revealed that trust in the government, particularly the perceived transparency of government actions, was most strongly associated with concerns regarding the secondary use of data. Conclusions: Using a mixed method approach involving a 2-wave survey and in-depth interview data, we expanded our understanding of privacy decisions and the privacy calculus in the context of digital contact tracing. The opposite influences of privacy concerns and perceived benefit on use intention suggest that the privacy calculus in TraceTogether might be viewed as a rational process of weighing between privacy risks and use benefits to make an uptake decision. However, our study demonstrated that existing perceptions toward the provider and the government in the contact tracing context, as well as the perception of the community triggered by TraceTogether use, may bias user appraisals of privacy risks and the benefits of contact tracing. %M 38451602 %R 10.2196/48986 %U https://mhealth.jmir.org/2024/1/e48986 %U https://doi.org/10.2196/48986 %U http://www.ncbi.nlm.nih.gov/pubmed/38451602 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e44406 %T Mobile Apps for COVID-19 Detection and Diagnosis for Future Pandemic Control: Multidimensional Systematic Review %A Gheisari,Mehdi %A Ghaderzadeh,Mustafa %A Li,Huxiong %A Taami,Tania %A Fernández-Campusano,Christian %A Sadeghsalehi,Hamidreza %A Afzaal Abbasi,Aaqif %+ School of Nursing and Health Sciences of Boukan, Urmia University of Medical Sciences, Kurdistan Blv Boukan, Urmia, 5951715161, Iran, 98 9129378390, Mustaf.ghaderzadeh@sbmu.ac.ir %K COVID-19 %K detection %K diagnosis %K internet of things %K cloud computing %K mobile applications %K mobile app %K mobile apps %K artificial intelligence: AI %K mobile phone %K smartphone %D 2024 %7 22.2.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: In the modern world, mobile apps are essential for human advancement, and pandemic control is no exception. The use of mobile apps and technology for the detection and diagnosis of COVID-19 has been the subject of numerous investigations, although no thorough analysis of COVID-19 pandemic prevention has been conducted using mobile apps, creating a gap. Objective: With the intention of helping software companies and clinical researchers, this study provides comprehensive information regarding the different fields in which mobile apps were used to diagnose COVID-19 during the pandemic. Methods: In this systematic review, 535 studies were found after searching 5 major research databases (ScienceDirect, Scopus, PubMed, Web of Science, and IEEE). Of these, only 42 (7.9%) studies concerned with diagnosing and detecting COVID-19 were chosen after applying inclusion and exclusion criteria using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. Results: Mobile apps were categorized into 6 areas based on the content of these 42 studies: contact tracing, data gathering, data visualization, artificial intelligence (AI)–based diagnosis, rule- and guideline-based diagnosis, and data transformation. Patients with COVID-19 were identified via mobile apps using a variety of clinical, geographic, demographic, radiological, serological, and laboratory data. Most studies concentrated on using AI methods to identify people who might have COVID-19. Additionally, symptoms, cough sounds, and radiological images were used more frequently compared to other data types. Deep learning techniques, such as convolutional neural networks, performed comparatively better in the processing of health care data than other types of AI techniques, which improved the diagnosis of COVID-19. Conclusions: Mobile apps could soon play a significant role as a powerful tool for data collection, epidemic health data analysis, and the early identification of suspected cases. These technologies can work with the internet of things, cloud storage, 5th-generation technology, and cloud computing. Processing pipelines can be moved to mobile device processing cores using new deep learning methods, such as lightweight neural networks. In the event of future pandemics, mobile apps will play a critical role in rapid diagnosis using various image data and clinical symptoms. Consequently, the rapid diagnosis of these diseases can improve the management of their effects and obtain excellent results in treating patients. %M 38231538 %R 10.2196/44406 %U https://mhealth.jmir.org/2024/1/e44406 %U https://doi.org/10.2196/44406 %U http://www.ncbi.nlm.nih.gov/pubmed/38231538 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48700 %T Investigating Citizens’ Acceptance of Contact Tracing Apps: Quantitative Study of the Role of Trust and Privacy %A Fox,Grace %A van der Werff,Lisa %A Rosati,Pierangelo %A Lynn,Theo %+ Irish Institute of Digital Business, Dublin City University, Collins Ave, Dublin9, Dublin, Ireland, 353 1 700 6873, theo.lynn@dcu.ie %K privacy %K trust %K public health surveillance %K contact tracing %K mobile apps %K adoption %K information disclosure %D 2024 %7 18.1.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic accelerated the need to understand citizen acceptance of health surveillance technologies such as contact tracing (CT) apps. Indeed, the success of these apps required widespread public acceptance and the alleviation of concerns about privacy, surveillance, and trust. Objective: This study aims to examine the factors that foster a sense of trust and a perception of privacy in CT apps. Our study also investigates how trust and perceived privacy influence citizens’ willingness to adopt, disclose personal data, and continue to use these apps. Methods: Drawing on privacy calculus and procedural fairness theories, we developed a model of the antecedents and behavioral intentions related to trust and privacy perceptions. We used structural equation modeling to test our hypotheses on a data set collected at 2 time points (before and after the launch of a national CT app). The sample consisted of 405 Irish residents. Results: Trust in CT apps was positively influenced by propensity to trust technology (β=.074; P=.006), perceived need for surveillance (β=.119; P<.001), and perceptions of government motives (β=.671; P<.001) and negatively influenced by perceived invasion (β=−.224; P<.001). Perceived privacy was positively influenced by trust (β=.466; P<.001) and perceived control (β=.451; P<.001) and negatively influenced by perceived invasion (β=−.165; P<.001). Prelaunch intentions toward adoption were influenced by trust (β=.590; P<.001) and perceived privacy (β=.247; P<.001). Prelaunch intentions to disclose personal data to the app were also influenced by trust (β=.215; P<.001) and perceived privacy (β=.208; P<.001) as well as adoption intentions before the launch (β=.550; P<.001). However, postlaunch intentions to use the app were directly influenced by prelaunch intentions (β=.530; P<.001), but trust and perceived privacy only had an indirect influence. Finally, with regard to intentions to disclose after the launch, use intentions after the launch (β=.665; P<.001) and trust (β=.215; P<.001) had a direct influence, but perceived privacy only had an indirect influence. The proposed model explained 74.4% of variance in trust, 91% of variance in perceived privacy, 66.6% of variance in prelaunch adoption intentions, 45.9% of variance in postlaunch use intentions, and 83.9% and 79.4% of variance in willingness to disclose before the launch and after the launch, respectively. Conclusions: Positive perceptions of trust and privacy can be fostered through clear communication regarding the need and motives for CT apps, the level of control citizens maintain, and measures to limit invasive data practice. By engendering these positive beliefs before launch and reinforcing them after launch, citizens may be more likely to accept and use CT apps. These insights are important for the launch of future apps and technologies that require mass acceptance and information disclosure. %M 38085914 %R 10.2196/48700 %U https://mhealth.jmir.org/2024/1/e48700 %U https://doi.org/10.2196/48700 %U http://www.ncbi.nlm.nih.gov/pubmed/38085914 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43105 %T Effects of User-Reported Risk Factors and Follow-Up Care Activities on Satisfaction With a COVID-19 Chatbot: Cross-Sectional Study %A Singh,Akanksha %A Schooley,Benjamin %A Patel,Nitin %+ IT & Cybersecurity, Department of Electrical and Computer Engineering, Brigham Young University, 240 Engineering Building, Provo, UT, 84602, United States, 1 8014220027, Ben_Schooley@byu.edu %K patient engagement %K chatbot %K population health %K health recommender systems %K conversational recommender systems %K design factors %K COVID-19 %D 2023 %7 14.12.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic influenced many to consider methods to reduce human contact and ease the burden placed on health care workers. Conversational agents or chatbots are a set of technologies that may aid with these challenges. They may provide useful interactions for users, potentially reducing the health care worker burden while increasing user satisfaction. Research aims to understand these potential impacts of chatbots and conversational recommender systems and their associated design features. Objective: The objective of this study was to evaluate user perceptions of the helpfulness of an artificial intelligence chatbot that was offered free to the public in response to COVID-19. The chatbot engaged patients and provided educational information and the opportunity to report symptoms, understand personal risks, and receive referrals for care. Methods: A cross-sectional study design was used to analyze 82,222 chats collected from patients in South Carolina seeking services from the Prisma Health system. Chi-square tests and multinomial logistic regression analyses were conducted to assess the relationship between reported risk factors and perceived chat helpfulness using chats started between April 24, 2020, and April 21, 2022. Results: A total of 82,222 chat series were started with at least one question or response on record; 53,805 symptom checker questions with at least one COVID-19–related activity series were completed, with 5191 individuals clicking further to receive a virtual video visit and 2215 clicking further to make an appointment with a local physician. Patients who were aged >65 years (P<.001), reported comorbidities (P<.001), had been in contact with a person with COVID-19 in the last 14 days (P<.001), and responded to symptom checker questions that placed them at a higher risk of COVID-19 (P<.001) were 1.8 times more likely to report the chat as helpful than those who reported lower risk factors. Users who engaged with the chatbot to conduct a series of activities were more likely to find the chat helpful (P<.001), including seeking COVID-19 information (3.97-4.07 times), in-person appointments (2.46-1.99 times), telehealth appointments with a nearby provider (2.48-1.9 times), or vaccination (2.9-3.85 times) compared with those who did not perform any of these activities. Conclusions: Chatbots that are designed to target high-risk user groups and provide relevant actionable items may be perceived as a helpful approach to early contact with the health system for assessing communicable disease symptoms and follow-up care options at home before virtual or in-person contact with health care providers. The results identified and validated significant design factors for conversational recommender systems, including triangulating a high-risk target user population and providing relevant actionable items for users to choose from as part of user engagement. %M 38096007 %R 10.2196/43105 %U https://mhealth.jmir.org/2023/1/e43105 %U https://doi.org/10.2196/43105 %U http://www.ncbi.nlm.nih.gov/pubmed/38096007 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45875 %T A Web-Based COVID-19 Tool for Testing Residents in Retirement Homes: Development Study %A Davoodi,Mansoor %A Batista,Ana %A Mertel,Adam %A Senapati,Abhishek %A Abdussalam,Wildan %A Vyskocil,Jiri %A Barbieri,Giuseppe %A Fan,Kai %A Schlechte-Welnicz,Weronika %A M Calabrese,Justin %+ Center for Advanced Systems Understanding, Untermarkt 20, Görlitz, 02826, Germany, 49 3581375237, m.davoodi-monfared@hzdr.de %K application %K COVID-19 %K optimized testing %K pandemic %K retirement home %K web application %D 2023 %7 21.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Long-term care facilities have been widely affected by the COVID-19 pandemic. Empirical evidence demonstrated that older people are the most impacted and are at higher risk of mortality after being infected. Regularly testing care facility residents is a practical approach to detecting infections proactively. In many cases, the care staff must perform the tests on the residents while also providing essential care, which in turn causes imbalances in their working time. Once an outbreak occurs, suppressing the spread of the virus in retirement homes (RHs) is challenging because the residents are in contact with each other, and isolation measures cannot be widely enforced. Regular testing strategies, on the other hand, have been shown to effectively prevent outbreaks in RHs. However, high-frequency testing may consume substantial staff working time, which results in a trade-off between the time invested in testing and the time spent providing essential care to residents. Objective: We developed a web application (Retirement Home Testing Optimizer) to assist RH managers in identifying effective testing schedules for residents. The outcome of the app, called the “testing strategy,” is based on dividing facility residents into groups and then testing no more than 1 group per day. Methods: We created the web application by incorporating influential factors such as the number of residents and staff, the average rate of contacts, the amount of time spent to test, and constraints on the test interval and size of groups. We developed mixed integer nonlinear programming models for balancing staff workload in long-term care facilities while minimizing the expected detection time of a probable infection inside the facility. Additionally, by leveraging symmetries in the problem, we proposed a fast and efficient local search method to find the optimal solution. Results: Considering the number of residents and staff and other practical constraints of the facilities, the proposed application computes the optimal trade-off testing strategy and suggests the corresponding grouping and testing schedule for residents. The current version of the application is deployed on the server of the Where2Test project and is accessible on their website. The application is open source, and all contents are offered in English and German. We provide comprehensive instructions and guidelines for easy use and understanding of the application’s functionalities. The application was launched in July 2022, and it is currently being tested in RHs in Saxony, Germany. Conclusions: Recommended testing strategies by our application are tailored to each RH and the goals set by the managers. We advise the users of the application that the proposed model and approach focus on the expected scenarios, that is, the expected risk of infection, and they do not guarantee the avoidance of worst-case scenarios. %M 37988136 %R 10.2196/45875 %U https://formative.jmir.org/2023/1/e45875 %U https://doi.org/10.2196/45875 %U http://www.ncbi.nlm.nih.gov/pubmed/37988136 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e45481 %T Adoption of a COVID-19 Contact Tracing App by Czech Youth: Cross-Cultural Replication Study %A Dolezel,Michal %A Smutny,Zdenek %+ Faculty of Informatics and Statistics, Prague University of Economics and Business, W. Churchill Sq. 4, Prague, 13067, Czech Republic, 420 224 09 5476, michal.dolezel@vse.cz %K contact tracing %K proximity tracing %K digital contact tracing %K Health Belief Model %K technology adoption %K COVID-19 %K qualitative verification %K Health Belief Model approach %K pandemic crisis %K eRouska %K eMask %D 2023 %7 16.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: During the worldwide COVID-19 pandemic crisis, the role of digital contact tracing (DCT) intensified. However, the uptake of this technology expectedly differed among age cohorts and national cultures. Various conceptual tools were introduced to strengthen DCT research from a theoretical perspective. However, little has been done to compare theory-supported findings across different cultural contexts and age cohorts. Objective: Building on the original study conducted in Belgium in April 2020 and theoretically underpinned by the Health Belief Model (HBM), this study attempted to confirm the predictors of DCT adoption in a cultural environment different from the original setting, that is, the Czech Republic. In addition, by using brief qualitative evidence, it aimed to shed light on the possible limitations of the HBM in the examined context and to propose certain extensions of the HBM. Methods: A Czech version of the original instrument was administered to a convenience sample of young (aged 18-29 y) Czech adults in November 2020. After filtering, 519 valid responses were obtained and included in the quantitative data analysis, which used structural equation modeling and followed the proposed structure of the relationships among the HBM constructs. Furthermore, a qualitative thematic analysis of the free-text answers was conducted to provide additional insights about the model’s validity in the given context. Results: The proposed measurement model exhibited less optimal fit (root mean square error of approximation=0.065, 90% CI 0.060-0.070) than in the original study (root mean square error of approximation=0.036, 90% CI 0.033-0.039). Nevertheless, perceived benefits and perceived barriers were confirmed as the main, statistically significant predictors of DCT uptake, consistent with the original study (β=.60, P<.001 and β=−.39; P<.001, respectively). Differently from the original study, self-efficacy was not a significant predictor in the strict statistical sense (β=.12; P=.003). In addition, qualitative analysis demonstrated that in the given cohort, perceived barriers was the most frequent theme (166/354, 46.9% of total codes). Under this category, psychological fears and concerns was a subtheme, notably diverging from the original operationalization of the perceived barriers construct. In a similar sense, a role for social influence in DCT uptake processes was suggested by some respondents (12/354, 1.7% of total codes). In summary, the quantitative and qualitative results indicated that the proposed quantitative model seemed to be of limited value in the examined context. Conclusions: Future studies should focus on reconceptualizing the 2 underperforming constructs (ie, perceived severity and cues to action) by considering the qualitative findings. This study also provided actionable insights for policy makers and app developers to mitigate DCT adoption issues in the event of a future pandemic caused by unknown viral agents. %M 37971804 %R 10.2196/45481 %U https://humanfactors.jmir.org/2023/1/e45481 %U https://doi.org/10.2196/45481 %U http://www.ncbi.nlm.nih.gov/pubmed/37971804 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47219 %T Community-Based Digital Contact Tracing of Emerging Infectious Diseases: Design and Implementation Study With Empirical COVID-19 Cases %A Wang,Hsiao-Chi %A Lin,Ting-Yu %A Yao,Yu-Chin %A Hsu,Chen-Yang %A Yang,Chang-Jung %A Chen,Tony Hsiu-Hsi %A Yeh,Yen-Po %+ Changhua County Public Health Bureau, No.162, Sec. 2, Jhongshan Rd., Changhua County, 500, Taiwan, 886 4 7115141, yeh.leego@gmail.com %K COVID-19 %K digital contact tracing %K public health %K surveillance %D 2023 %7 8.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Contact tracing for containing emerging infectious diseases such as COVID-19 is resource intensive and requires digital transformation to enable timely decision-making. Objective: This study demonstrates the design and implementation of digital contact tracing using multimodal health informatics to efficiently collect personal information and contain community outbreaks. The implementation of digital contact tracing was further illustrated by 3 empirical SARS-CoV-2 infection clusters. Methods: The implementation in Changhua, Taiwan, served as a demonstration of the multisectoral informatics and connectivity between electronic health systems needed for digital contact tracing. The framework incorporates traditional travel, occupation, contact, and cluster approaches and a dynamic contact process enabled by digital technology. A centralized registry system, accessible only to authorized health personnel, ensures privacy and data security. The efficiency of the digital contact tracing system was evaluated through a field study in Changhua. Results: The digital contact tracing system integrates the immigration registry, communicable disease report system, and national health records to provide real-time information about travel, occupation, contact, and clusters for potential contacts and to facilitate a timely assessment of the risk of COVID-19 transmission. The digitalized system allows for informed decision-making regarding quarantine, isolation, and treatment, with a focus on personal privacy. In the first cluster infection, the system monitored 665 contacts and isolated 4 (0.6%) cases; none of the contacts (0/665, 0%) were infected during quarantine. The estimated reproduction number of 0.92 suggests an effective containment strategy for preventing community-acquired outbreak. The system was also used in a cluster investigation involving foreign workers, where none of the 462 contacts (0/462, 0%) tested positive for SARS-CoV-2. Conclusions: By integrating the multisectoral database, the contact tracing process can be digitalized to provide the information required for risk assessment and decision-making in a timely manner to contain a community-acquired outbreak when facing the outbreak of emerging infectious disease. %M 37938887 %R 10.2196/47219 %U https://www.jmir.org/2023/1/e47219 %U https://doi.org/10.2196/47219 %U http://www.ncbi.nlm.nih.gov/pubmed/37938887 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45549 %T Smartphone Apps for Containing the COVID-19 Pandemic in Germany: Qualitative Interview Study With Experts Based on Grounded Theory %A Krämer,Dennis %A Brachem,Elisabeth %A Schneider-Reuter,Lydia %A D'Angelo,Isabella %A Vollmann,Jochen %A Haltaufderheide,Joschka %+ Faculty of Social Sciences, Georg-August-University Göttingen, Sprangerweg 2, Göttingen, 37075, Germany, 49 5513925656, dennis.kraemer@uni-goettingen.de %K Corona-Warn-App %K COVID-19 pandemic %K eHealth %K Germany %K health technology %K mobile phone %K qualitative research %K sovereignty %K transparency %D 2023 %7 20.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone apps, including those for digital contact tracing (DCT), played a crucial role in containing infections during the COVID-19 pandemic. Their primary function is to generate and disseminate information to disrupt transmissions based on various events, such as encounters, vaccinations, locations, or infections. Although the functionality of these apps has been extensively studied, there is still a lack of qualitative research addressing critical issues. Objective: We will demonstrate that the use of DCT presents a challenge due to the tension between continuous health monitoring and uncertainties related to transparency and user sovereignty. On one hand, DCT enables the monitoring of various risk factors, including data-based calculations of infection probabilities. On the other hand, continuous risk management is intertwined with several uncertainties, including the unclear storage of personal data, who has access to it, and how it will be used in the future. Methods: We focus on the German “Corona-Warn-App” and support our argument with empirical data from 19 expert interviews conducted between 2020 and 2021. The interviews were conducted using a semistructured questionnaire and analyzed according to the principles of grounded theory. Results: Our data underscores 3 dimensions: transparency, data sovereignty, and the east-west divide. While transparency is considered an essential foundation for establishing trust in the use of DCT by providing a sense of security, data sovereignty is seen as a high value during the pandemic, protecting users from an undesired loss of control. The aspect of the east-west divide highlights the idea of incorporating sociocultural values and standards into technology, emphasizing that algorithms and data-driven elements, such as distance indicators, encounters, and isolations, are also influenced by sociocultural factors. Conclusions: The effective use of DCT for pandemic containment relies on achieving a balance between individual control and technological prevention. Maximizing the technological benefits of these tools is crucial. However, users must also be mindful of the information they share and maintain control over their shared data. %M 37862068 %R 10.2196/45549 %U https://www.jmir.org/2023/1/e45549 %U https://doi.org/10.2196/45549 %U http://www.ncbi.nlm.nih.gov/pubmed/37862068 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e38072 %T Tracking Changes in Mobility Before and After the First SARS-CoV-2 Vaccination Using Global Positioning System Data in England and Wales (Virus Watch): Prospective Observational Community Cohort Study %A Nguyen,Vincent %A Liu,Yunzhe %A Mumford,Richard %A Flanagan,Benjamin %A Patel,Parth %A Braithwaite,Isobel %A Shrotri,Madhumita %A Byrne,Thomas %A Beale,Sarah %A Aryee,Anna %A Fong,Wing Lam Erica %A Fragaszy,Ellen %A Geismar,Cyril %A Navaratnam,Annalan M D %A Hardelid,Pia %A Kovar,Jana %A Pope,Addy %A Cheng,Tao %A Hayward,Andrew %A Aldridge,Robert %A , %+ Centre for Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 20 3549 5541, r.aldridge@ucl.ac.uk %K COVID-19 %K SARS-CoV-2 %K vaccination %K global positioning system %K GPS %K movement tracking %K geographical tracking %K mobile app %K health application %K surveillance %K public health %K mHealth %K mobile surveillance %K tracking device %K geolocation %D 2023 %7 8.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Evidence suggests that individuals may change adherence to public health policies aimed at reducing the contact, transmission, and spread of the SARS-CoV-2 virus after they receive their first SARS-CoV-2 vaccination when they are not fully vaccinated. Objective: We aimed to estimate changes in median daily travel distance of our cohort from their registered addresses before and after receiving a SARS-CoV-2 vaccine. Methods: Participants were recruited into Virus Watch starting in June 2020. Weekly surveys were sent out to participants, and vaccination status was collected from January 2021 onward. Between September 2020 and February 2021, we invited 13,120 adult Virus Watch participants to contribute toward our tracker subcohort, which uses the GPS via a smartphone app to collect data on movement. We used segmented linear regression to estimate the median daily travel distance before and after the first self-reported SARS-CoV-2 vaccine dose. Results: We analyzed the daily travel distance of 249 vaccinated adults. From 157 days prior to vaccination until the day before vaccination, the median daily travel distance was 9.05 (IQR 8.06-10.09) km. From the day of vaccination to 105 days after vaccination, the median daily travel distance was 10.08 (IQR 8.60-12.42) km. From 157 days prior to vaccination until the vaccination date, there was a daily median decrease in mobility of 40.09 m (95% CI –50.08 to –31.10; P<.001). After vaccination, there was a median daily increase in movement of 60.60 m (95% CI 20.90-100; P<.001). Restricting the analysis to the third national lockdown (January 4, 2021, to April 5, 2021), we found a median daily movement increase of 18.30 m (95% CI –19.20 to 55.80; P=.57) in the 30 days prior to vaccination and a median daily movement increase of 9.36 m (95% CI 38.6-149.00; P=.69) in the 30 days after vaccination. Conclusions: Our study demonstrates the feasibility of collecting high-volume geolocation data as part of research projects and the utility of these data for understanding public health issues. Our various analyses produced results that ranged from no change in movement after vaccination (during the third national lock down) to an increase in movement after vaccination (considering all periods, up to 105 days after vaccination), suggesting that, among Virus Watch participants, any changes in movement distances after vaccination are small. Our findings may be attributable to public health measures in place at the time such as movement restrictions and home working that applied to the Virus Watch cohort participants during the study period. %M 36884272 %R 10.2196/38072 %U https://publichealth.jmir.org/2023/1/e38072 %U https://doi.org/10.2196/38072 %U http://www.ncbi.nlm.nih.gov/pubmed/36884272 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38555 %T mHealth App to Facilitate Remote Care for Patients With COVID-19: Rapid Development of the DrCovid+ App %A Tan,Jamaica Pei Ying %A Tan,Michelle W J %A Towle,Rachel Marie %A Lee,Joanne Sze Win %A Lei,Xiaofeng %A Liu,Yong %A Goh,Rick Siow Mong %A Chee Ping,Franklin Tan %A Tan,Teck Choon %A Ting,Daniel Shu Wei %A Lee,Chen Ee %A Low,Lian Leng %+ Population Health and Integrated Care Office, Singapore General Hospital, 10 Hospital Boulevard, SingHealth Tower Level 7, Singapore, 168582, Singapore, 65 69703018, low.lian.leng@singhealth.com.sg %K mobile health %K mHealth %K rapid development %K remote care %K COVID-19 %K hospital-at-home %K mobile app %K app development %K virtual care %K Telegram service %K clinical care %K continuity of care %K digital health %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The 2019 novel COVID-19 has severely burdened the health care system through its rapid transmission. Mobile health (mHealth) is a viable solution to facilitate remote monitoring and continuity of care for patients with COVID-19 in a home environment. However, the conceptualization and development of mHealth apps are often time and labor-intensive and are laden with concerns relating to data security and privacy. Implementing mHealth apps is also a challenging feat as language-related barriers limit adoption, whereas its perceived lack of benefits affects sustained use. The rapid development of an mHealth app that is cost-effective, secure, and user-friendly will be a timely enabler. Objective: This project aimed to develop an mHealth app, DrCovid+, to facilitate remote monitoring and continuity of care for patients with COVID-19 by using the rapid development approach. It also aimed to address the challenges of mHealth app adoption and sustained use. Methods: The Rapid Application Development approach was adopted. Stakeholders including decision makers, physicians, nurses, health care administrators, and research engineers were engaged. The process began with requirements gathering to define and finalize the project scope, followed by an iterative process of developing a working prototype, conducting User Acceptance Tests, and improving the prototype before implementation. Co-designing principles were applied to ensure equal collaborative efforts and collective agreement among stakeholders. Results: DrCovid+ was developed on Telegram Messenger and hosted on a cloud server. It features a secure patient enrollment and data interface, a multilingual communication channel, and both automatic and personalized push messaging. A back-end dashboard was also developed to collect patients’ vital signs for remote monitoring and continuity of care. To date, 400 patients have been enrolled into the system, amounting to 2822 hospital bed–days saved. Conclusions: The rapid development and implementation of DrCovid+ allowed for timely clinical care management for patients with COVID-19. It facilitated early patient hospital discharge and continuity of care while addressing issues relating to data security and labor-, time-, and cost-effectiveness. The use case for DrCovid+ may be extended to other medical conditions to advance patient care and empowerment within the community, thereby meeting existing and rising population health challenges. %M 36649223 %R 10.2196/38555 %U https://formative.jmir.org/2023/1/e38555 %U https://doi.org/10.2196/38555 %U http://www.ncbi.nlm.nih.gov/pubmed/36649223 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43241 %T Promoting Hand Hygiene During the COVID-19 Pandemic: Parallel Randomized Trial for the Optimization of the Soapp App %A Baretta,Dario %A Amrein,Melanie Alexandra %A Bäder,Carole %A Ruschetti,Gian Giacomo %A Rüttimann,Carole %A Del Rio Carral,Maria %A Fabian,Carlo %A Inauen,Jennifer %+ Institute of Psychology, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland, 41 31 684 58 96, dario.baretta@unibe.ch %K COVID-19 %K hand hygiene %K behavior change intervention %K Multiphase Optimization Strategy %K MOST %K smartphone apps %K motivation %K habit %K social norm %K mobile phone %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hand hygiene is an effective behavior for preventing the spread of the respiratory disease COVID-19 and was included in public health guidelines worldwide. Behavior change interventions addressing hand hygiene have the potential to support the adherence to public health recommendations and, thereby, prevent the spread of COVID-19. However, randomized trials are largely absent during a pandemic; therefore, there is little knowledge about the most effective strategies to promote hand hygiene during an ongoing pandemic. This study addresses this gap by presenting the results of the optimization phase of a Multiphase Optimization Strategy of Soapp, a smartphone app for promoting hand hygiene in the context of the COVID-19 pandemic. Objective: This study aimed to identify the most effective combination and sequence of 3 theory- and evidence-based intervention modules (habit, motivation, and social norms) for promoting hand hygiene. To this end, 9 versions of Soapp were developed (conditions), and 2 optimization criteria were defined: the condition with the largest increase in hand hygiene at follow-up and condition with the highest engagement, usability, and satisfaction based on quantitative and qualitative analyses. Methods: This study was a parallel randomized trial with 9 intervention conditions defined by the combination of 2 intervention modules and their sequence. The trial was conducted from March to August 2021 with interested participants from the Swiss general population (N=232; randomized). Randomization was performed using Qualtrics (Qualtrics International Inc), and blinding was ensured. The duration of the intervention was 34 days. The primary outcome was self-reported hand hygiene at follow-up, which was assessed using an electronic diary. The secondary outcomes were user engagement, usability, and satisfaction assessed at follow-up. Nine participants were further invited to participate in semistructured exit interviews. A set of ANOVAs was performed to test the main hypotheses, whereas a thematic analysis was performed to analyze the qualitative data. Results: The results showed a significant increase in hand hygiene over time across all conditions. There was no interaction effect between time and intervention condition. Similarly, no between-group differences in engagement, usability, and satisfaction emerged. Seven themes (eg, “variety and timeliness of the task load” and “social interaction”) were found in the thematic analysis. Conclusions: The effectiveness of Soapp in promoting hand hygiene laid the foundation for the next evaluation phase of the app. More generally, the study supported the value of digital interventions in pandemic contexts. The findings showed no differential effect of intervention conditions involving different combinations and sequences of the habit, motivation, and social norms modules on hand hygiene, engagement, usability, and satisfaction. In the absence of quantitative differences, we relied on the results from the thematic analysis to select the best version of Soapp for the evaluation phase. Trial Registration: ClinicalTrials.gov NCT04830761; https://clinicaltrials.gov/ct2/show/NCT04830761 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-055971 %M 36599056 %R 10.2196/43241 %U https://mhealth.jmir.org/2023/1/e43241 %U https://doi.org/10.2196/43241 %U http://www.ncbi.nlm.nih.gov/pubmed/36599056 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43639 %T Use of and Satisfaction With Mobile Health Education During the COVID-19 Pandemic in Thailand: Cross-sectional Study %A Kittipimpanon,Kamonrat %A Noyudom,Angun %A Panjatharakul,Pawanrat %A Visudtibhan,Poolsuk Janepanish %+ Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand, 66 814376763, angun.ket@mahidol.ac.th %K mHealth %K COVID-19 %K chatbot %K use %K satisfaction %D 2023 %7 24.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: RamaCovid is a mobile health (mHealth) education system that provides the Thai population with information about COVID-19 and self-risk assessment. RamaCovid has a chatbot system that provides automatic conversations (available 24 hours per day) and a live chat function that allows users to directly communicate with health professionals (available 4 hours per day in the evening). The system consists of (1) COVID-19 vaccine information, (2) self-care after vaccination, (3) frequently asked questions, (4) self-risk assessment, (5) hospital finding, (6) contact number finding, and (7) live chat with a health professional. Objective: This study investigates the use of and satisfaction with the RamaCovid system. Methods: Overall, 400 people were recruited via RamaCovid by broadcasting an infographic about the study. Questionnaires collected demographic data, users’ experiences of RamaCovid, and the use of and satisfaction with the system. The questions were answered using a 5-point Likert scale. Descriptive statistics were used to describe the participant characteristics and their use of and satisfaction with the RamaCovid system. The Mann-Whitney U test was performed to examine the difference in use and satisfaction between the adult and older adult groups. Results: The participants showed high use of and satisfaction with the RamaCovid system. They used the information to take care of themselves and their family, and they gained information about their COVID-19 risk. The users were satisfied with the system because the information was easy to understand, trustworthy, and up to date. However, the older adult group had lower use of and satisfaction with the system compared to the adult group. Conclusions: RamaCovid is an example of the successful implementation of mHealth education. It was an alternative way to work with the call center during the COVID-19 pandemic and increased access to health information and health care services. Providing ongoing updated information, improving the attractiveness of the media information, and the age group difference are important issues for further system development. %M 36596210 %R 10.2196/43639 %U https://formative.jmir.org/2023/1/e43639 %U https://doi.org/10.2196/43639 %U http://www.ncbi.nlm.nih.gov/pubmed/36596210 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e39570 %T Using a Proximity-Detection Technology to Nudge for Physical Distancing in a Swedish Workplace During the COVID-19 Pandemic: Retrospective Case Study %A Villius Zetterholm,My %A Nilsson,Lina %A Jokela,Päivi %+ Department of Informatics, Faculty of Technology, Linnaeus University, Universitetsplatsen 1, Kalmar, 39231, Sweden, 46 480497711, my.villiuszetterholm@lnu.se %K case study %K COVID-19 %K feasibility %K mixed methods %K nudging %K physical distance %K preventive behavior %K preventive technologies %K proximity detecting technology %K wearables %D 2022 %7 12.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The recent COVID-19 pandemic has contributed to the emergence of several technologies for infectious disease management. Although much focus has been placed on contact-tracing apps, another promising new tactic is proximity tracing, which focuses on health-related behavior and can be used for primary prevention. Underpinned by theories on behavioral design, a proximity-detection system can be devised that provides a user with immediate nudges to maintain physical distance from others. However, the practical feasibility of proximity detection during an infectious disease outbreak has not been sufficiently investigated. Objective: We aimed to evaluate the feasibility of using a wearable device to nudge for distance and to gather important insights about how functionality and interaction are experienced by users. The results of this study can guide future research and design efforts in this emerging technology. Methods: In this retrospective case study, a wearable proximity-detection technology was used in a workplace for 6 weeks during the production of a music competition. The purpose of the technology was to nudge users to maintain their physical distance using auditory feedback. We used a mixed methods sequential approach, including interviews (n=8) and a survey (n=30), to compile the experiences of using wearable technology in a real-life setting. Results: We generated themes from qualitative analysis based on data from interviews and open-text survey responses. The quantitative data were subsequently integrated into these themes: feasibility (implementation and acceptance—establishing a shared problem; distance tags in context—strategy, environment, and activities; understanding and learning; and accomplishing the purpose) and design aspects (a purposefully annoying device; timing, tone, and proximity; and additional functions). Conclusions: This empirical study reports on the feasibility of using wearable technology based on proximity detection to nudge individuals to maintain physical distance in the workplace. The technology supports attention to distance, but the usability of this approach is dependent on the context and situation. In certain situations, the audio signal is frustrating, but most users agree that it needs to be annoying to ensure sufficient behavioral adaption. We proposed a dual nudge that involves vibration followed by sound. There are indications that the technology also facilitates learning how to maintain a greater distance from others, and that this behavior can persist beyond the context of technology use. This study demonstrates that the key value of this technology is that it places the user in control and enables immediate action when the distance to others is not maintained. This study provides insights into the emerging field of personal and wearable technologies used for primary prevention during infectious disease outbreaks. Future research is needed to evaluate the preventive effect on transmission and investigate behavioral changes in detail and in relation to different forms of feedback. %M 36343202 %R 10.2196/39570 %U https://formative.jmir.org/2022/12/e39570 %U https://doi.org/10.2196/39570 %U http://www.ncbi.nlm.nih.gov/pubmed/36343202 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e41689 %T Effectiveness of Mental Health Apps for Distress During COVID-19 in US Unemployed and Essential Workers: Remote Pragmatic Randomized Clinical Trial %A Comtois,Katherine Anne %A Mata-Greve,Felicia %A Johnson,Morgan %A Pullmann,Michael D %A Mosser,Brittany %A Arean,Patricia %+ Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 Pacific Stree NE, Seattle, WA, 98195, United States, 1 14152727222, parean@uw.edu %K COVID-19 %K COVID %K coronavirus %K pandemic %K SARS-CoV-2 %K essential worker %K suicide %K suicidal %K commercial app %K mental health apps %K health app %K mental health %K mHealth %K mobile health %K occupational health %K employee %K employment %K unemployed %K worker %K job %K depression %K anxiety %K stress %K distress %K mobile app %K RCT %K pragmatic trial %K randomized %K health care worker %K health care provider %K frontline staff %D 2022 %7 7.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During the COVID-19 pandemic, the general public was concerned about the mental health impacts of unemployment due to COVID-19 and the stress essential workers experienced during this time. Several reports indicated that people in distress were turning to digital technology, but there was little evidence about the impact of these tools on mitigating distress. Objective: This study seeks to determine the acceptability, feasibility, usability, and effectiveness of mobile mental health apps for decreasing mental health symptoms in essential workers and unemployed individuals with suicide risk. Methods: We recruited participants who indicated that they were unemployed because of COVID-19 or were COVID-19–designated essential workers. Participants were randomized to 1 of 4 free commercial mobile apps for managing distress that were (1) highly rated by PsyberGuide and (2) met the criteria for intervention features these participants indicated were desirable in a previous survey. Participants used the apps for 4 weeks and completed baseline and 4-week self-assessments of depression, anxiety emotional regulation, and suicide risk. Results: We found no differences between the apps in any outcome but did find significant changes in depression and anxiety over time (Patient Health Questionnaire [PHQ]-9: estimate=–1.5, SE 0.2, 95% CI –1.1 to –1.8, P<.001; Generalized Anxiety Disorder Scale [GAD]-7: estimate=–1.3, SE 0.2, 95% CI –1.0 to –1.6, P<.001). We found no significant changes in suicidal behavior (Suicide Behaviors Questionnaire-Revised [SBQ-R]) or emotional regulation (Difficulties in Emotion Regulation Scale – Short Form [DERS-SF]) for the 4 weeks. We did find a significant dose-response pattern for changes in depression and anxiety. Using the app at least once a week resulted in greater improvements in treatment conditions over time on depression (estimate=–0.6, SE 0.2, 95% CI 1.0-0.2, P=.003) and anxiety (estimate=0.1, SE 0.2, 95% CI 0.4-0.6, P=.78). There was no association between app frequency and changes in suicidal behavior (SBQ-R) or emotional regulation (DERS-SF). We further found a significant difference between the conditions with regard to app usability, with the control app being the most usable (meanBeautiful Mood 72.9, SD 16.7; meanCOVID Coach 71.2, SD 15.4; meanCalm 66.8, SD 17.3; mean7 Cups 65.2, SD 17.7). We found no significant differences for app acceptability or appropriateness. Conclusions: Few studies have evaluated prospectively the utility and usability of commercial apps for mood. This study found that free, self-guided commercial mobile mental health apps are seen as usable, but no one app is superior to the other. Although we found that regular use is indicated for effects on depression and anxiety to occur in those who are more symptomatic, regression to the mean cannot be ruled out. Trial Registration: ClinicalTrials.gov NCT04536935; https://tinyurl.com/mr36zx3s %M 36191176 %R 10.2196/41689 %U https://mhealth.jmir.org/2022/11/e41689 %U https://doi.org/10.2196/41689 %U http://www.ncbi.nlm.nih.gov/pubmed/36191176 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e36412 %T Using Digital Tools for Contact Tracing to Improve COVID-19 Safety in Schools: Qualitative Study Exploring Views and Experiences Among School Staff %A Chantziara,Sofia %A Brigden L C,Amberly %A Mccallum,Claire H %A Craddock,Ian J %+ Faculty of Engineering, University of Bristol, Merchant Venturers Building, 75 Woodland Rd, Bristol, BS81UB, United Kingdom, 44 0117 928, amberly.brigden@bristol.ac.uk %K schools %K contact tracing %K COVID-19 mitigation %K COVID-19 %K pandemic %K disease prevention %K health technology %K COVID-19 management %K technology support %K digital tool %K mobile health %K mobile technology %D 2022 %7 1.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Throughout the pandemic, governments worldwide have issued guidelines to manage the spread and impact of COVID-19 in schools, including measures around social distancing and contact tracing. Whether schools required support to implement these guidelines has not yet been explored in depth. Despite the development of a range of technologies to tackle COVID-19, such as contact-tracing apps and electronic vaccine certificates, research on their usefulness in school settings has been limited. Objective: The aim of the study was to explore the needs of school staff in managing COVID-19 and their experiences and perspectives on technological support in relation to contact tracing. School staff are the ones likely to make key implementation decisions regarding new technologies, and they are also the ones responsible for using the new tools daily. Including both management staff and class teachers in the development of school-based technologies can lead to their successful adoption by schools. Methods: Semistructured interviews were conducted with UK school staff, including primary and secondary school teachers and school managers. Thematic analysis, facilitated by NVivo, was used to analyze the data. Two of the authors independently coded 5 (28%) of the interviews and reached a consensus on a coding framework. Results: Via purposive sampling, we recruited 18 participants from 5 schools. Findings showed that primary schools did not perform contact tracing, while in secondary schools, digital seating plans were used to identify close contacts in the classroom and manual investigations were also conducted identify social contacts. Participants reported that despite their efforts, high-risk interactions between students were not adequately monitored. There was a need to improve accuracy when identifying close contacts in common areas where students congregate. Proximity tracking, use of access cards, and closed-circuit television (CCTV) emerged as potential solutions, but there were concerns surrounding false alerts, burden, and security. Conclusions: School staff have found it difficult to monitor and implement social distancing and contact-tracing provisions. There are opportunities for mobile digital technologies and CCTV to support school staff in keeping their students and colleagues safe; however, these must place minimal demands on staff and prioritize security measures. Study findings can help researchers and practitioners who work in different contexts and settings understand what particular challenges are faced by school staff, and inform further research on the design and application of digital solutions for contact tracing. %M 36191172 %R 10.2196/36412 %U https://formative.jmir.org/2022/11/e36412 %U https://doi.org/10.2196/36412 %U http://www.ncbi.nlm.nih.gov/pubmed/36191172 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e40233 %T Effectiveness, Policy, and User Acceptance of COVID-19 Contact-Tracing Apps in the Post–COVID-19 Pandemic Era: Experience and Comparative Study %A Liu,MingXin %A Zhou,SiYu %A Jin,Qun %A Nishimura,Shoji %A Ogihara,Atsushi %+ Graduate School of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, 3591192, Japan, 81 04 2949 8111, liumingxin98@akane.waseda.jp %K COVID-19 %K contact-tracing app %K digital contact tracing %K mobile phone %D 2022 %7 27.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In the post–COVID-19 pandemic era, many countries have launched apps to trace contacts of COVID-19 infections. Each contact-tracing app (CTA) faces a variety of issues owing to different national policies or technologies for tracing contacts. Objective: In this study, we aimed to investigate all the CTAs used to trace contacts in various countries worldwide, including the technology used by each CTA, the availability of knowledge about the CTA from official websites, the interoperability of CTAs in various countries, and the infection detection rates and policies of the specific country that launched the CTA, and to summarize the current problems of the apps based on the information collected. Methods: We investigated CTAs launched in all countries through Google, Google Scholar, and PubMed. We experimented with all apps that could be installed and compiled information about apps that could not be installed or used by consulting official websites and previous literature. We compared the information collected by us on CTAs with relevant previous literature to understand and analyze the data. Results: After screening 166 COVID-19 apps developed in 197 countries worldwide, we selected 98 (59%) apps from 95 (48.2%) countries, of which 63 (66.3%) apps were usable. The methods of contact tracing are divided into 3 main categories: Bluetooth, geolocation, and QR codes. At the technical level, CTAs face 3 major problems. First, the distance and time for Bluetooth- and geolocation-based CTAs to record contact are generally set to 2 meters and 15 minutes; however, this distance should be lengthened, and the time should be shortened for more infectious variants. Second, Bluetooth- or geolocation-based CTAs also face the problem of lack of accuracy. For example, individuals in 2 adjacent vehicles during traffic jams may be at a distance of ≤2 meters to make the CTA trace contact, but the 2 users may actually be separated by car doors, which could prevent transmission and infection. In addition, we investigated infection detection rates in 33 countries, 16 (48.5%) of which had significantly low infection detection rates, wherein CTAs could have lacked effectiveness in reducing virus propagation. Regarding policy, CTAs in most countries can only be used in their own countries and lack interoperability among other countries. In addition, 7 countries have already discontinued CTAs, but we believe that it was too early to discontinue them. Regarding user acceptance, 28.6% (28/98) of CTAs had no official source of information that could reduce user acceptance. Conclusions: We surveyed all CTAs worldwide, identified their technological policy and acceptance issues, and provided solutions for each of the issues we identified. This study aimed to provide useful guidance and suggestions for updating the existing CTAs and the subsequent development of new CTAs. %M 36190741 %R 10.2196/40233 %U https://publichealth.jmir.org/2022/10/e40233 %U https://doi.org/10.2196/40233 %U http://www.ncbi.nlm.nih.gov/pubmed/36190741 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e41395 %T The Potential Role of an Adjunctive Real-Time Locating System in Preventing Secondary Transmission of SARS-CoV-2 in a Hospital Environment: Retrospective Case-Control Study %A Kim,Min Hyung %A Ryu,Un Hyoung %A Heo,Seok-Jae %A Kim,Yong Chan %A Park,Yoon Soo %+ Division of Infectious Diseases, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si, 16995, Republic of Korea, 82 10 8502 5825, ysparkok2@yuhs.ac %K real-time locating system %K COVID-19 %K contact tracing %K secondary transmission %K SARS-CoV-2 %D 2022 %7 18.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been an increasing demand for new technologies regarding infection control in hospital settings to reduce the burden of contact tracing. Objective: This study aimed to compare the validity of a real-time locating system (RTLS) with that of the conventional contact tracing method for identifying high-risk contact cases associated with the secondary transmission of SARS-CoV-2. Methods: A retrospective case-control study involving in-hospital contact cases of confirmed COVID-19 patients, who were diagnosed from January 23 to March 25, 2022, was conducted at a university hospital in South Korea. Contact cases were identified using either the conventional method or the RTLS. The primary endpoint of this study was secondary transmission of SARS-CoV-2 among contact cases. Univariate and multivariable logistic regression analysis comparing test positive and versus negative contact cases were performed. Results: Overall, 509 and 653 cases were confirmed by the conventional method and the RTLS, respectively. Only 74 contact cases were identified by both methods, which could be attributed to the limitations of each method. Sensitivity was higher for the RTLS tracing method (653/1088, 60.0%) than the conventional tracing method (509/1088, 46.8%) considering all contact cases identified by both methods. The secondary transmission rate in the RTLS model was 8.1%, while that in the conventional model was 5.3%. The multivariable logistic regression model revealed that the RTLS was more capable of detecting secondary transmission than the conventional method (adjusted odds ratio 6.15, 95% CI 1.92-28.69; P=.007). Conclusions: This study showed that the RTLS is beneficial when used as an adjunctive approach to the conventional method for contact tracing associated with secondary transmission. However, the RTLS cannot completely replace traditional contact tracing. %M 36197844 %R 10.2196/41395 %U https://www.jmir.org/2022/10/e41395 %U https://doi.org/10.2196/41395 %U http://www.ncbi.nlm.nih.gov/pubmed/36197844 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36003 %T Optimizing the Acceptability, Adherence, and Inclusiveness of the COVID Radar Surveillance App: Qualitative Study Using Focus Groups, Thematic Content Analysis, and Usability Testing %A Splinter,Bas %A Saadah,Nicholas H %A Chavannes,Niels H %A Kiefte-de Jong,Jessica C %A Aardoom,Jiska J %+ Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2300 RC, Netherlands, 31 071 526 843, J.J.Aardoom@lumc.nl %K COVID-19 %K corona %K eHealth %K self-report %K mobile app %K track-and-trace strategies %K population surveillance %K citizen science %K usability %K mobile phone %D 2022 %7 9.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID Radar app was developed as a population-based surveillance instrument to identify at-risk populations and regions in response to the COVID-19 pandemic. The app boasts of >8.5 million completed questionnaires, with >280,000 unique users. Although the COVID Radar app is a valid tool for population-level surveillance, high user engagement is critical to the success of the COVID Radar app in maintaining validity. Objective: This study aimed to identify optimization targets of the COVID Radar app to improve its acceptability, adherence, and inclusiveness. Methods: The main component of the COVID Radar app is a self-report questionnaire that assesses COVID-19 symptoms and social distancing behaviors. A total of 3 qualitative substudies were conducted. First, 3 semistructured focus group interviews with end users (N=14) of the app were conducted to gather information on user experiences. The output was transcribed and thematically coded using the framework method. Second, a similar qualitative thematic analysis was conducted on 1080 end-user emails. Third, usability testing was conducted in one-on-one sessions with 4 individuals with low literacy levels. Results: All 3 substudies identified optimization targets in terms of design and content. The results of substudy 1 showed that the participants generally evaluated the app positively. They reported the app to be user-friendly and were satisfied with its design and functionalities. Participants’ main motivation to use the app was to contribute to science. Participants suggested adding motivational tools to stimulate user engagement. A larger national publicity campaign for the app was considered potentially helpful for increasing the user population. In-app updates informing users about the project and its outputs motivated users to continue using the app. Feedback on the self-report questionnaire, stemming from substudies 1 and 2, mostly concerned the content and phrasing of the questions. Furthermore, the section of the app allowing users to compare their symptoms and behaviors to those of their peers was found to be suboptimal because of difficulties in interpreting the figures presented in the app. Finally, the output of substudy 3 resulted in recommendations primarily related to simplification of the text to render it more accessible and comprehensible for individuals with low literacy levels. Conclusions: The convenience of app use, enabling personal adjustments of the app experience, and considering motivational factors for continued app use (ie, altruism and collectivism) were found to be crucial to procuring and maintaining a population of active users of the COVID Radar app. Further, there seems to be a need to increase the accessibility of public health tools for individuals with low literacy levels. These results can be used to improve the this and future public health apps and improve the representativeness of their user populations and user engagement, ultimately increasing the validity of the tools. %M 35781492 %R 10.2196/36003 %U https://formative.jmir.org/2022/9/e36003 %U https://doi.org/10.2196/36003 %U http://www.ncbi.nlm.nih.gov/pubmed/35781492 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e34212 %T The Effect of Persuasive Design on the Adoption of Exposure Notification Apps: Quantitative Study Based on COVID Alert %A Oyibo,Kiemute %A Morita,Plinio Pelegrini %+ School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 41372, plinio.morita@uwaterloo.ca %K contact tracing app %K exposure notification app %K COVID Alert %K COVID-19 %K persuasive technology %K behavior change %K exposure %K behavior %K effect %K design %K adoption %K use %K case study %K effectiveness %K user interface %K mobile phone %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The adoption of contact tracing apps worldwide has been low. Although considerable research has been conducted on technology acceptance, little has been done to show the benefit of incorporating persuasive principles. Objective: This research aimed to investigate the effect of persuasive features in the COVID Alert app, created by Health Canada, by focusing on the no-exposure status, exposure status, and diagnosis report interfaces. Methods: We conducted a study among 181 Canadian residents, including 65 adopters and 116 nonadopters. This study was based on screenshots of the 3 interfaces, of which each comprised a persuasive design and a control design. The persuasive versions of the first two interfaces supported self-monitoring (of exposure levels), and that of the third interface supported social learning (about how many other users have reported their diagnosis). The 6 screenshots were randomly assigned to 6 groups of participants to provide feedback on perceived persuasiveness and adoption willingness. Results: A multivariate repeated-measure ANOVA showed that there is an interaction among interface, app design, and adoption status regarding the perceived persuasiveness of the interfaces. This resulted in a 2-way ANOVA for each interface. For the no-exposure interface, there was an interaction between adoption status and app design. Among adopters, there was no significant difference P=.31 between the persuasive design (mean 5.36, SD 1.63) and the control design (mean 5.87, SD 1.20). However, among nonadopters, there was an effect of app design (P<.001), with participants being more motivated by the persuasive design (mean 5.37, SD 1.30) than by the control design (mean 4.57, SD 1.19). For the exposure interface, adoption status had a main effect (P<.001), with adopters (mean 5.91, SD 1.01) being more motivated by the designs than nonadopters (mean 4.96, SD 1.43). For the diagnosis report interface, there was an interaction between adoption status and app design. Among nonadopters, there was no significant difference P=.99 between the persuasive design (mean 4.61, SD 1.84) and the control design (mean 4.77, SD 1.21). However, among adopters, there was an effect of app design (P=.006), with participants being more likely to report their diagnosis using the persuasive design (mean 6.00, SD 0.97) than using the control design (mean 5.03, SD 1.22). Finally, with regard to willingness to download the app, pairwise comparisons showed that nonadopters were more likely to adopt the app after viewing the persuasive version of the no-exposure interface (13/21, 62% said yes) and the diagnosis report interface (12/17, 71% said yes) than after viewing the control versions (3/17, 18% and 7/16, 44%, respectively, said yes). Conclusions: Exposure notification apps are more likely to be effective if equipped with persuasive features. Incorporating self-monitoring into the no-exposure status interface and social learning into the diagnosis report interface can increase adoption by >30%. %M 35580138 %R 10.2196/34212 %U https://formative.jmir.org/2022/9/e34212 %U https://doi.org/10.2196/34212 %U http://www.ncbi.nlm.nih.gov/pubmed/35580138 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e31099 %T Factors Associated With Using the COVID-19 Mobile Contact-Tracing App Among Individuals Diagnosed With SARS-CoV-2 in Amsterdam, the Netherlands: Observational Study %A Ritsema,Feiko %A Bosdriesz,Jizzo R %A Leenstra,Tjalling %A Petrignani,Mariska W F %A Coyer,Liza %A Schreijer,Anja J M %A van Duijnhoven,Yvonne T H P %A van de Wijgert,Janneke H H M %A Schim van der Loeff,Maarten F %A Matser,Amy %+ Department of Infectious Diseases, GGD Amsterdam, Nieuwe Achtergracht 100, Amsterdam, 1018WT, Netherlands, 31 649616442, jbosdriesz@ggd.amsterdam.nl %K COVID-19 %K contact tracing %K mobile contact tracing app %K pandemic %K mHealth %K digital health %K contact tracing app %K mobile applications %K health applications %K public health %K surveillance %D 2022 %7 24.8.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Worldwide, efforts are being made to stop the COVID-19 pandemic caused by SARS-CoV-2. Contact tracing and quarantining are key in limiting SARS-CoV-2 transmission. Mathematical models have shown that the time between infection, isolation of cases, and quarantining of contacts are the most important components that determine whether the pandemic can be controlled. Mobile contact-tracing apps could accelerate the tracing and quarantining of contacts, including anonymous contacts. However, real-world observational data on the uptake and determinants of contact-tracing apps are limited. Objective: The aim of this paper is to assess the use of a national Dutch contact-tracing app among notified cases diagnosed with SARS-CoV-2 infection and investigate which characteristics are associated with the use of the app. Methods: Due to privacy regulations, data from the app could not be used. Instead, we used anonymized SARS-CoV-2 routine contact-tracing data collected between October 28, 2020, and February 26, 2021, in the region of Amsterdam, the Netherlands. Complete case logistic regression analysis was performed to identify which factors (age, gender, country of birth, municipality, number of close contacts, and employment in either health care or education) were associated with using the app. Age and number of close contacts were modelled as B-splines due to their nonlinear relationship. Results: Of 29,766 SARS-CoV-2 positive cases, 4824 (16.2%) reported app use. Median age of cases was 41 (IQR 29-55) years, and 46.7% (n=13,898) were male. In multivariable analysis, males (adjusted odds ratio [AOR] 1.11, 95% CI 1.04-1.18) and residents of municipalities surrounding Amsterdam were more likely to use the app (Aalsmeer AOR 1.34, 95% CI 1.13-1.58; Ouder-Amstel AOR 1.96, 95% CI 1.54-2.50), while people born outside the Netherlands, particularly those born in non-Western countries (AOR 0.33, 95% CI 0.30-0.36), were less likely to use the app. Odds of app use increased with age until the age of 58 years and decreased sharply thereafter (P<.001). Odds of app use increased with number of contacts, peaked at 8 contacts, and then decreased (P<.001). Individuals working in day care, home care, and elderly nursing homes were less likely to use the app. Conclusions: Contact-tracing app use among people with confirmed SARS-CoV-2 infection was low in the region of Amsterdam. This diminishes the potential impact of the app by hampering the ability to warn contacts. Use was particularly low among older people, people born outside the Netherlands, and people with many contacts. Use of the app was also relatively low compared to those from some other European countries, some of which had additional features beyond contact tracing, making them potentially more appealing. For the Dutch contact-tracing app to have an impact, uptake needs to be higher; therefore, investing more into promotional efforts and additional features could be considered. %M 35867842 %R 10.2196/31099 %U https://mhealth.jmir.org/2022/8/e31099 %U https://doi.org/10.2196/31099 %U http://www.ncbi.nlm.nih.gov/pubmed/35867842 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 7 %P e35195 %T Data Management and Privacy Policy of COVID-19 Contact-Tracing Apps: Systematic Review and Content Analysis %A Bardus,Marco %A Al Daccache,Melodie %A Maalouf,Noel %A Al Sarih,Rayan %A Elhajj,Imad H %+ Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 0121 414 3344, marco.bardus@gmail.com %K COVID-19 %K mobile applications %K contact tracing %D 2022 %7 12.7.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: COVID-19 digital contact-tracing apps were created to assist public health authorities in curbing the pandemic. These apps require users’ permission to access specific functions on their mobile phones, such as geolocation, Bluetooth or Wi-Fi connections, or personal data, to work correctly. As these functions have privacy repercussions, it is essential to establish how contact-tracing apps respect users’ privacy. Objective: This study aimed to systematically map existing contact-tracing apps and evaluate the permissions required and their privacy policies. Specifically, we evaluated the type of permissions, the privacy policies’ readability, and the information included in them. Methods: We used custom Google searches and existing lists of contact-tracing apps to identify potentially eligible apps between May 2020 and November 2021. We included contact-tracing or exposure notification apps with a Google Play webpage from which we extracted app characteristics (eg, sponsor, number of installs, and ratings). We used Exodus Privacy to systematically extract the number of permissions and classify them as dangerous or normal. We computed a Permission Accumulated Risk Score representing the threat level to the user’s privacy. We assessed the privacy policies’ readability and evaluated their content using a 13-item checklist, which generated a Privacy Transparency Index. We explored the relationships between app characteristics, Permission Accumulated Risk Score, and Privacy Transparency Index using correlations, chi-square tests, or ANOVAs. Results: We identified 180 contact-tracing apps across 152 countries, states, or territories. We included 85.6% (154/180) of apps with a working Google Play page, most of which (132/154, 85.7%) had a privacy policy document. Most apps were developed by governments (116/154, 75.3%) and totaled 264.5 million installs. The average rating on Google Play was 3.5 (SD 0.7). Across the 154 apps, we identified 94 unique permissions, 18% (17/94) of which were dangerous, and 30 trackers. The average Permission Accumulated Risk Score was 22.7 (SD 17.7; range 4-74, median 16) and the average Privacy Transparency Index was 55.8 (SD 21.7; range 5-95, median 55). Overall, the privacy documents were difficult to read (median grade level 12, range 7-23); 67% (88/132) of these mentioned that the apps collected personal identifiers. The Permission Accumulated Risk Score was negatively associated with the average App Store ratings (r=−0.20; P=.03; 120/154, 77.9%) and Privacy Transparency Index (r=−0.25; P<.001; 132/154, 85.7%), suggesting that the higher the risk to one’s data, the lower the apps’ ratings and transparency index. Conclusions: Many contact-tracing apps were developed covering most of the planet but with a relatively low number of installs. Privacy-preserving apps scored high in transparency and App Store ratings, suggesting that some users appreciate these apps. Nevertheless, privacy policy documents were difficult to read for an average audience. Therefore, we recommend following privacy-preserving and transparency principles to improve contact-tracing uptake while making privacy documents more readable for a wider public. %M 35709334 %R 10.2196/35195 %U https://mhealth.jmir.org/2022/7/e35195 %U https://doi.org/10.2196/35195 %U http://www.ncbi.nlm.nih.gov/pubmed/35709334 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 7 %P e30976 %T The Efficacy of “Foundations,” a Digital Mental Health App to Improve Mental Well-being During COVID-19: Proof-of-Principle Randomized Controlled Trial %A Catuara-Solarz,Silvina %A Skorulski,Bartlomiej %A Estella-Aguerri,Iñaki %A Avella-Garcia,Claudia Bibiana %A Shepherd,Sarah %A Stott,Emily %A Hemmings,Nicola R %A Ruiz de Villa,Aleix %A Schulze,Laura %A Dix,Sophie %+ Koa Health, Carrer de la Ciutat de Granada 121, Barcelona, 08018, Spain, 44 7702 500882, sophie.dix@koahealth.com %K mental well-being %K digital health %K cognitive behavioral therapy %K positive psychology %K insomnia %K COVID-19 %K mental health %K mobile app %K anxiety %K health app %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Against a long-term trend of increasing demand, the COVID-19 pandemic has led to a global rise in common mental disorders. Now more than ever, there is an urgent need for scalable, evidence-based interventions to support mental well-being. Objective: The aim of this proof-of-principle study was to evaluate the efficacy of a mobile-based app in adults with self-reported symptoms of anxiety and stress in a randomized control trial that took place during the first wave of the COVID-19 pandemic in the United Kingdom. Methods: Adults with mild to severe anxiety and moderate to high levels of perceived stress were randomized to either the intervention or control arm. Participants in the intervention arm were given access to the Foundations app for the duration of the 4-week study. All participants were required to self-report a range of validated measures of mental well-being (10-item Connor-Davidson Resilience scale [CD-RISC-10], 7-item Generalized Anxiety Disorder scale [GAD-7], Office of National Statistics Four Subjective Well-being Questions [ONS-4], World Health Organization-5 Well-Being Index [WHO-5]) and sleep (Minimal Insomnia Scale [MISS]) at baseline and at weeks 2 and 4. The self-reported measures of perceived stress (10-item Perceived Stress Score [PSS-10]) were obtained weekly. Results: A total of 136 participants completed the study and were included in the final analysis. The intervention group (n=62) showed significant improvements compared to the control group (n=74) on measures of anxiety, with a mean GAD-7 score change from baseline of –1.35 (SD 4.43) and –0.23 (SD 3.24), respectively (t134=1.71, P=.04); resilience, with a mean change in CD-RISC score of 1.79 (SD 4.08) and –0.31 (SD 3.16), respectively (t134=–3.37, P<.001); sleep, with a mean MISS score change of –1.16 (SD 2.67) and –0.26 (SD 2.29), respectively (t134=2.13, P=.01); and mental well-being, with a mean WHO-5 score change of 1.53 (SD 5.30) and –0.23 (SD 4.20), respectively (t134=–2.16, P=.02), within 2 weeks of using Foundations, with further improvements emerging at week 4. Perceived stress was also reduced within the intervention group, although the difference did not reach statistical significance relative to the control group, with a PSS score change from baseline to week 2 of –2.94 (SD 6.84) and –2.05 (SD 5.34), respectively (t134= 0.84, P=.20). Conclusions: This study provides a proof of principle that the digital mental health app Foundations can improve measures of mental well-being, anxiety, resilience, and sleep within 2 weeks of use, with greater effects after 4 weeks. Foundations therefore offers potential as a scalable, cost-effective, and accessible solution to enhance mental well-being, even during times of crisis such as the COVID-19 pandemic. Trial Registration: OSF Registries osf.io/f6djb; https://osf.io/vm3xq %M 34978535 %R 10.2196/30976 %U https://mhealth.jmir.org/2022/7/e30976 %U https://doi.org/10.2196/30976 %U http://www.ncbi.nlm.nih.gov/pubmed/34978535 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e33951 %T Modeling Trust in COVID-19 Contact-Tracing Apps Using the Human-Computer Trust Scale: Online Survey Study %A Sousa,Sonia %A Kalju,Tiina %+ School of Digital Technologies, Tallinn University, Narva mnt, 29, Tallinn, 10120, Estonia, 372 53921116, scs@tlu.ee %K human-computer interaction %K COVID-19 %K human factors %K trustworthy AI %K contact-tracing %K app %K safety %K trust %K artificial intelligence %K Estonia %K case study %K monitoring %K surveillance %K perspective %K awareness %K design %K covid %K mobile app %K mHealth %K mobile health %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has caused changes in technology use worldwide, both socially and economically. This pandemic crisis has brought additional measures such as contact-tracing apps (CTAs) to help fight against spread of the virus. Unfortunately, the low adoption rate of these apps affected their success. There could be many reasons for the low adoption, including concerns of security and privacy, along with reported issues of trust in CTAs. Some concerns are related with how CTAs could be used as surveillance tools or their potential threats to privacy as they involve health data. For example, in Estonia, the CTA named HOIA had approximately 250,000 downloads in the middle of January 2021. However, in 2021, only 4.7% of the population used HOIA as a COVID-19 CTA. The reasons for the low adoption include lack of competency, and privacy and security concerns. This lower adoption and the lack of trustworthiness persist despite efforts of the European Union in building ethics and trustworthy artificial intelligence (AI)-based apps. Objective: The aim of this study was to understand how to measure trust in health technologies. Specifically, we assessed the usefulness of the Human-Computer Trust Scale (HCTS) to measure Estonians’ trust in the HOIA app and the causes for this lack of trust. Methods: The main research question was: Can the HCTS be used to assess citizens’ perception of trust in health technologies? We established four hypotheses that were tested with a survey. We used a convenience sample for data collection, including sharing the questionnaire on social network sites and using the snowball method to reach all potential HOIA users in the Estonian population. Results: Among the 78 respondents, 61 had downloaded the HOIA app with data on usage patterns. However, 20 of those who downloaded the app admitted that it was never opened despite most claiming to regularly use mobile apps. The main reasons included not understanding how it works, and privacy and security concerns. Significant correlations were found between participants’ trust in CTAs in general and their perceived trust in the HOIA app regarding three attributes: competency (P<.001), risk perception (P<.001), and reciprocity (P=.01). Conclusions: This study shows that trust in the HOIA app among Estonian residents did affect their predisposition to use the app. Participants did not generally believe that HOIA could help to control the spread of the virus. The result of this work is limited to HOIA and health apps that use similar contact-tracing methods. However, the findings can contribute to gaining a broader understanding and awareness of the need for designing trustworthy technologies. Moreover, this work can help to provide design recommendations that ensure trustworthiness in CTAs, and the ability of AI to use highly sensitive data and serve society. %M 35699973 %R 10.2196/33951 %U https://humanfactors.jmir.org/2022/2/e33951 %U https://doi.org/10.2196/33951 %U http://www.ncbi.nlm.nih.gov/pubmed/35699973 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e36065 %T Monitoring Symptoms of COVID-19: Review of Mobile Apps %A Schmeelk,Suzanna %A Davis,Alison %A Li,Qiaozheng %A Shippey,Caroline %A Utah,Michelle %A Myers,Annie %A Reading Turchioe,Meghan %A Masterson Creber,Ruth %+ Weill Cornell Medicine, 425 E 61st Street, New York, NY, 10065, United States, 1 9144340731, rmc2009@med.cornell.edu %K COVID-19 %K mobile apps %K mobile health %K mHealth %K symptom assessment %K symptom tracking %K public health %K mobile health application %K surveillance %K digital surveillance %K monitoring system %K digital health %D 2022 %7 1.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps have facilitated symptom monitoring of COVID-19 symptoms globally and have been used to share data with health care professionals and support disease prediction, prevention, management, diagnostics, and improvements in treatments and patient education. Objective: The aim of this review is to evaluate the quality and functionality of COVID-19 mHealth apps that support tracking acute and long-term symptoms of COVID-19. Methods: We systematically reviewed commercially available mHealth apps for COVID-19 symptom monitoring by searching Google Play and Apple iTunes using search terms such as “COVID-19,” “Coronavirus,” and “COVID-19 and symptoms.” All apps underwent three rounds of screening. The final apps were independently assessed using the Mobile Application Rating Scale (MARS), an informatics functionality scoring system, and the Center for Disease Control and World Health Organization symptom guidelines. The MARS is a 19-item standardized tool to evaluate the quality of mHealth apps on engagement, functionality, aesthetics, and information quality. Functionality was quantified across the following criteria: inform, instruct, record (collect, share, evaluate, and intervene), display, guide, remind or alert, and communicate. Interrater reliability between the reviewers was calculated. Results: A total of 1017 mobile apps were reviewed, and 20 (2%) met the inclusion criteria. The majority of the 20 included apps (n=18, 90%) were designed to track acute COVID-19 symptoms, and only 2 (10%) addressed long-term symptoms. Overall, the apps scored high on quality, with an overall MARS rating of 3.89 out of 5, and the highest domain score for functionality (4.2). The most common functionality among all apps was the instruct function (n=19, 95%). The most common symptoms included in the apps for tracking were fever and dry cough (n=18, 90%), aches and pains (n=17, 85%), difficulty breathing (n=17, 85%), tiredness, sore throat, headache, loss of taste or smell (n=16, 80%), and diarrhea (n=15, 75%). Only 2 (10%) apps specifically tracked long-term symptoms of COVID-19. The top 4 rated apps overall were state-specific apps developed and deployed for public use. Conclusions: Overall, mHealth apps designed to monitor symptoms of COVID-19 were of high quality, but the majority of apps focused almost exclusively on acute symptoms. Future apps should also incorporate monitoring long-term symptoms of COVID-19 and evidence-based educational materials; they should also include a feature that would allow patients to communicate their symptoms to specific caregivers or their own health care team. App developers should also follow updated technical and clinical guidelines from the Center for Disease Control and the World Health Organization. %M 35609313 %R 10.2196/36065 %U https://mhealth.jmir.org/2022/6/e36065 %U https://doi.org/10.2196/36065 %U http://www.ncbi.nlm.nih.gov/pubmed/35609313 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36238 %T Global User-Level Perception of COVID-19 Contact Tracing Applications: Data-Driven Approach Using Natural Language Processing %A Ahmad,Kashif %A Alam,Firoj %A Qadir,Junaid %A Qolomany,Basheer %A Khan,Imran %A Khan,Talhat %A Suleman,Muhammad %A Said,Naina %A Hassan,Syed Zohaib %A Gul,Asma %A Househ,Mowafa %A Al-Fuqaha,Ala %+ Information and Computing Technology Division, College of Science and Engineering, Hamad Bin Khalifa University, LAS Building, Education City, Doha, Qatar, 974 50694322, aalfuqaha@hbku.edu.qa %K COVID-19 %K sentiment analysis %K contact tracing applications %K NLP %K text classification %K BERT %K fastText %K transformers %K RoBerta %D 2022 %7 11.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Contact tracing has been globally adopted in the fight to control the infection rate of COVID-19. To this aim, several mobile apps have been developed. However, there are ever-growing concerns over the working mechanism and performance of these applications. The literature already provides some interesting exploratory studies on the community’s response to the applications by analyzing information from different sources, such as news and users’ reviews of the applications. However, to the best of our knowledge, there is no existing solution that automatically analyzes users’ reviews and extracts the evoked sentiments. We believe such solutions combined with a user-friendly interface can be used as a rapid surveillance tool to monitor how effective an application is and to make immediate changes without going through an intense participatory design method. Objective: In this paper, we aim to analyze the efficacy of AI and NLP techniques for automatically extracting and classifying the polarity of users’ sentiments by proposing a sentiment analysis framework to automatically analyze users’ reviews on COVID-19 contact tracing mobile apps. We also aim to provide a large-scale annotated benchmark data set to facilitate future research in the domain. As a proof of concept, we also developed a web application based on the proposed solutions, which is expected to help the community quickly analyze the potential of an application in the domain. Methods: We propose a pipeline starting from manual annotation via a crowd-sourcing study and concluding with the development and training of artificial intelligence (AI) models for automatic sentiment analysis of users’ reviews. In detail, we collected and annotated a large-scale data set of user reviews on COVID-19 contact tracing applications. We used both classical and deep learning methods for classification experiments. Results: We used 8 different methods on 3 different tasks, achieving up to an average F1 score of 94.8%, indicating the feasibility of the proposed solution. The crowd-sourcing activity resulted in a large-scale benchmark data set composed of 34,534 manually annotated reviews. Conclusions: The existing literature mostly relies on the manual or exploratory analysis of users’ reviews on applications, which is tedious and time-consuming. In existing studies, generally, data from fewer applications are analyzed. In this work, we showed that AI and natural language processing techniques provide good results for analyzing and classifying users’ sentiments’ polarity and that automatic sentiment analysis can help to analyze users’ responses more accurately and quickly. We also provided a large-scale benchmark data set. We believe the presented analysis, data set, and proposed solutions combined with a user-friendly interface can be used as a rapid surveillance tool to analyze and monitor mobile apps deployed in emergency situations leading to rapid changes in the applications without going through an intense participatory design method. %M 35389357 %R 10.2196/36238 %U https://formative.jmir.org/2022/5/e36238 %U https://doi.org/10.2196/36238 %U http://www.ncbi.nlm.nih.gov/pubmed/35389357 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e22544 %T Leveraging Polio Geographic Information System Platforms in the African Region for Mitigating COVID-19 Contact Tracing and Surveillance Challenges: Viewpoint %A Akpan,Godwin Ubong %A Bello,Isah Mohammed %A Touray,Kebba %A Ngofa,Reuben %A Oyaole,Daniel Rasheed %A Maleghemi,Sylvester %A Babona,Marie %A Chikwanda,Chanda %A Poy,Alain %A Mboussou,Franck %A Ogundiran,Opeayo %A Impouma,Benido %A Mihigo,Richard %A Yao,Nda Konan Michel %A Ticha,Johnson Muluh %A Tuma,Jude %A A Mohamed,Hani Farouk %A Kanmodi,Kehinde %A Ejiofor,Nonso Ephraim %A Kipterer,John Kapoi %A Manengu,Casimir %A Kasolo,Francis %A Seaman,Vincent %A Mkanda,Pascal %+ Regional Office of Africa, World Health Organization, World Health Organization,Regional Office for Africa, Cite Du Djoue, Brazzaville, 500101, Congo, 242 055736476, akpang@who.int %K contact tracing %K GIS %K COVID-19 %K surveillance %D 2022 %7 17.3.2022 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Background: The ongoing COVID-19 pandemic in Africa is an urgent public health crisis. Estimated models projected over 150,000 deaths and 4,600,000 hospitalizations in the first year of the disease in the absence of adequate interventions. Therefore, electronic contact tracing and surveillance have critical roles in decreasing COVID-19 transmission; yet, if not conducted properly, these methods can rapidly become a bottleneck for synchronized data collection, case detection, and case management. While the continent is currently reporting relatively low COVID-19 cases, digitized contact tracing mechanisms and surveillance reporting are necessary for standardizing real-time reporting of new chains of infection in order to quickly reverse growing trends and halt the pandemic. Objective: This paper aims to describe a COVID-19 contact tracing smartphone app that includes health facility surveillance with a real-time visualization platform. The app was developed by the AFRO (African Regional Office) GIS (geographic information system) Center, in collaboration with the World Health Organization (WHO) emergency preparedness and response team. The app was developed through the expertise and experience gained from numerous digital apps that had been developed for polio surveillance and immunization via the WHO’s polio program in the African region. Methods: We repurposed the GIS infrastructures of the polio program and the database structure that relies on mobile data collection that is built on the Open Data Kit. We harnessed the technology for visualization of real-time COVID-19 data using dynamic dashboards built on Power BI, ArcGIS Online, and Tableau. The contact tracing app was developed with the pragmatic considerations of COVID-19 peculiarities. The app underwent testing by field surveillance colleagues to meet the requirements of linking contacts to cases and monitoring chains of transmission. The health facility surveillance app was developed from the knowledge and assessment of models of surveillance at the health facility level for other diseases of public health importance. The Integrated Supportive Supervision app was added as an appendage to the pre-existing paper-based surveillance form. These two mobile apps collected information on cases and contact tracing, alongside alert information on COVID-19 reports at the health facility level; the information was linked to visualization platforms in order to enable actionable insights. Results: The contact tracing app and platform were piloted between April and June 2020; they were then put to use in Zimbabwe, Benin, Cameroon, Uganda, Nigeria, and South Sudan, and their use has generated some palpable successes with respect to COVID-19 surveillance. However, the COVID-19 health facility–based surveillance app has been used more extensively, as it has been used in 27 countries in the region. Conclusions: In light of the above information, this paper was written to give an overview of the app and visualization platform development, app and platform deployment, ease of replicability, and preliminary outcome evaluation of their use in the field. From a regional perspective, integration of contact tracing and surveillance data into one platform provides the AFRO with a more accurate method of monitoring countries’ efforts in their response to COVID-19, while guiding public health decisions and the assessment of risk of COVID-19. %M 34854813 %R 10.2196/22544 %U https://mhealth.jmir.org/2022/3/e22544 %U https://doi.org/10.2196/22544 %U http://www.ncbi.nlm.nih.gov/pubmed/34854813 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e30691 %T Digital Contact Tracing Apps for COVID-19: Development of a Citizen-Centered Evaluation Framework %A Tsvyatkova,Damyanka %A Buckley,Jim %A Beecham,Sarah %A Chochlov,Muslim %A O’Keeffe,Ian R %A Razzaq,Abdul %A Rekanar,Kaavya %A Richardson,Ita %A Welsh,Thomas %A Storni,Cristiano %A , %+ Department of Computer Science and Information Systems, University of Limerick, Computer Science Building, Plassey Park Rd, Limerick, V94 T9PX, Ireland, 353 61 202632, Cristiano.Storni@ul.ie %K COVID-19 %K mHealth %K digital contact tracing apps %K framework %K evaluation %K mobile health %K health apps %K digital health %K contact tracing %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The silent transmission of COVID-19 has led to an exponential growth of fatal infections. With over 4 million deaths worldwide, the need to control and stem transmission has never been more critical. New COVID-19 vaccines offer hope. However, administration timelines, long-term protection, and effectiveness against potential variants are still unknown. In this context, contact tracing and digital contact tracing apps (CTAs) continue to offer a mechanism to help contain transmission, keep people safe, and help kickstart economies. However, CTAs must address a wide range of often conflicting concerns, which make their development/evolution complex. For example, the app must preserve citizens’ privacy while gleaning their close contacts and as much epidemiological information as possible. Objective: In this study, we derived a compare-and-contrast evaluative framework for CTAs that integrates and expands upon existing works in this domain, with a particular focus on citizen adoption; we call this framework the Citizen-Focused Compare-and-Contrast Evaluation Framework (C3EF) for CTAs. Methods: The framework was derived using an iterative approach. First, we reviewed the literature on CTAs and mobile health app evaluations, from which we derived a preliminary set of attributes and organizing pillars. These attributes and the probing questions that we formulated were iteratively validated, augmented, and refined by applying the provisional framework against a selection of CTAs. Each framework pillar was then subjected to internal cross-team scrutiny, where domain experts cross-checked sufficiency, relevancy, specificity, and nonredundancy of the attributes, and their organization in pillars. The consolidated framework was further validated on the selected CTAs to create a finalized version of C3EF for CTAs, which we offer in this paper. Results: The final framework presents seven pillars exploring issues related to CTA design, adoption, and use: (General) Characteristics, Usability, Data Protection, Effectiveness, Transparency, Technical Performance, and Citizen Autonomy. The pillars encompass attributes, subattributes, and a set of illustrative questions (with associated example answers) to support app design, evaluation, and evolution. An online version of the framework has been made available to developers, health authorities, and others interested in assessing CTAs. Conclusions: Our CTA framework provides a holistic compare-and-contrast tool that supports the work of decision-makers in the development and evolution of CTAs for citizens. This framework supports reflection on design decisions to better understand and optimize the design compromises in play when evolving current CTAs for increased public adoption. We intend this framework to serve as a foundation for other researchers to build on and extend as the technology matures and new CTAs become available. %M 35084338 %R 10.2196/30691 %U https://mhealth.jmir.org/2022/3/e30691 %U https://doi.org/10.2196/30691 %U http://www.ncbi.nlm.nih.gov/pubmed/35084338 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e30872 %T Including the Public in Public eHealth: The Need for Community Participation in the Development of State-Sponsored COVID-19–Related Mobile Apps %A Idris,Muhammed Yassin %A Korin,Maya %A Araya,Faven %A Chowdhury,Sayeeda %A Medina,Patty %A Cruz,Larissa %A Hawkins,Trey-Rashad %A Brown,Humberto %A Claudio,Luz %+ Department of Medicine, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA, 30310, United States, 1 404 752 1500, myidris@msm.edu %K mobile apps %K COVID-19 %K CBPR %K digital health %K eHealth %K community health %K health disparities %D 2022 %7 9.3.2022 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The COVID-19 pandemic has overwhelmed health care systems worldwide, particularly in underresourced communities of color with a high prevalence of pre-existing health conditions. Many state governments and health care entities responded by increasing their capacity for telemedicine and disease tracking and creating mobile apps for dissemination of medical information. Our experiences with state-sponsored apps suggest that because many of these eHealth tools did not include community participation, they inadvertently contributed to widening digital health disparities. We propose that, as eHealth tools continue to expand as a form of health care, more attention needs to be given to their equitable distribution, accessibility, and usage. In this viewpoint collaboratively written by a minority-serving community-based organization and an eHealth academic research team, we present our experience participating in a community advisory board working on the dissemination of the COVID Alert NY mobile app to illustrate the importance of public participation in app development. We also provide practical recommendations on how to involve community representatives in the app development process. We propose that transparency and community involvement in the process of app development ultimately increases buy-in, trust, and usage of digital technology in communities where they are needed most. %M 35113793 %R 10.2196/30872 %U https://mhealth.jmir.org/2022/3/e30872 %U https://doi.org/10.2196/30872 %U http://www.ncbi.nlm.nih.gov/pubmed/35113793 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e31857 %T Attitudes Toward Mobile Apps for Pandemic Research Among Smartphone Users in Germany: National Survey %A Buhr,Lorina %A Schicktanz,Silke %A Nordmeyer,Eike %+ Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, Göttingen, 37073, Germany, 49 5513969009, sschick@gwdg.de %K user %K pandemic %K smartphone apps %K mobile apps %K telephone-based survey %K Germany %K data sharing %K data donation %K ethics %K trust %K COVID-19 %K mHealth %K mobile applications %K digital health %K health applications %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During the COVID-19 pandemic, but also in the context of previous epidemic diseases, mobile apps for smartphones were developed with different goals and functions, such as digital contact tracing, test management, symptom monitoring, quarantine compliance, and epidemiological and public health research. Objective: The aim of this study was to explore the potential for the acceptance of research-orientated apps (ROAs) in the German population. To this end, we identified distinctive attitudes toward pandemic apps and data sharing for research purposes among smartphone users in general and with a focus on differences in attitudes between app users and nonusers in particular. Methods: We conducted a cross-sectional, national, telephone-based survey of 1003 adults in Germany, of which 924 were useable for statistical analysis. The 17-item survey assessed current usage of pandemic apps, motivations for using or not using pandemic apps, trust in app distributors and attitudes toward data handling (data storage and transmission), willingness to share coded data with researchers using a pandemic app, social attitudes toward app use, and demographic and personal characteristics. Results: A vast majority stated that they used a smartphone (778/924, 84.2%), but less than half of the smartphone users stated that they used a pandemic app (326/778, 41.9%). The study focused on the subsample of smartphone users. Interestingly, when asked about preferred organizations for data storage and app distribution, trust in governmental (federal or state government, regional health office), public-appointed (statutory health insurance), or government-funded organizations (research institutes) was much higher than in private organizations (private research institutions, clinics, health insurances, information technology [IT] companies). Having a university degree significantly (P<.001) increased the likelihood of using a pandemic app, while having a migration background significantly (P<.001) decreased it. The overwhelming majority (653/778, 83.9%) of smartphone users were willing to provide their app data for state-funded research. Regarding attitudes toward app usage, striking differences between users and nonusers were found. Almost all app users (317/327, 96.9%) stated they would be willing to share data, whereas only 74.3% (336/452) of nonusers supported data sharing via an app. Two-thirds (216/326, 66.3%) of app users fully or rather agreed with the statement that using a pandemic app is a social duty, whereas almost the same proportion of nonusers entirely or rather disagreed with that statement (273/451, 60.5%). Conclusions: These findings indicate a high potential for the adoption of ROAs among smartphone users in Germany as long as organizational providers engaged in development, operation, and distribution are state-funded or governmental institutions and transparency about data-using research institutions is provided. %M 35072646 %R 10.2196/31857 %U https://mhealth.jmir.org/2022/1/e31857 %U https://doi.org/10.2196/31857 %U http://www.ncbi.nlm.nih.gov/pubmed/35072646 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e22113 %T Reasons for Nonuse, Discontinuation of Use, and Acceptance of Additional Functionalities of a COVID-19 Contact Tracing App: Cross-sectional Survey Study %A Walrave,Michel %A Waeterloos,Cato %A Ponnet,Koen %+ MIOS Research Group and GOVTRUST Centre of Excellence, Department of Communication Studies, Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, Antwerp, 2000, Belgium, 32 475459785, michel.walrave@uantwerp.be %K COVID-19 %K SARS-CoV-2 %K coronavirus %K contact tracing %K proximity tracing %K mHealth %K mobile app %K user acceptability %K surveillance %K privacy %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In several countries, contact tracing apps (CTAs) have been introduced to warn users if they have had high-risk contacts that could expose them to SARS-CoV-2 and could, therefore, develop COVID-19 or further transmit the virus. For CTAs to be effective, a sufficient critical mass of users is needed. Until now, adoption of these apps in several countries has been limited, resulting in questions on which factors prevent app uptake or stimulate discontinuation of app use. Objective: The aim of this study was to investigate individuals’ reasons for not using, or stopping use of, a CTA, in particular, the Coronalert app. Users’ and nonusers’ attitudes toward the app’s potential impact was assessed in Belgium. To further stimulate interest and potential use of a CTA, the study also investigated the population’s interest in new functionalities. Methods: An online survey was administered in Belgium to a sample of 1850 respondents aged 18 to 64 years. Data were collected between October 30 and November 2, 2020. Sociodemographic differences were assessed between users and nonusers. We analyzed both groups’ attitudes toward the potential impact of CTAs and their acceptance of new app functionalities. Results: Our data showed that 64.9% (1201/1850) of our respondents were nonusers of the CTA under study; this included individuals who did not install the app, those who downloaded but did not activate the app, and those who uninstalled the app. While we did not find any sociodemographic differences between users and nonusers, attitudes toward the app and its functionalities seemed to differ. The main reasons for not downloading and using the app were a perceived lack of advantages (308/991, 31.1%), worries about privacy (290/991, 29.3%), and, to a lesser extent, not having a smartphone (183/991, 18.5%). Users of the CTA agreed more with the potential of such apps to mitigate the consequences of the pandemic. Overall, nonusers found the possibility of extending the CTA with future functionalities to be less acceptable than users. However, among users, acceptability also tended to differ. Among users, functionalities relating to access and control, such as digital certificates or “green cards” for events, were less accepted (358/649, 55.2%) than functionalities focusing on informing citizens about the spread of the virus (453/649, 69.8%) or making an appointment to get tested (525/649, 80.9%). Conclusions: Our results show that app users were more convinced of the CTA’s utility and more inclined to accept new app features than nonusers. Moreover, nonusers had more CTA-related privacy concerns. Therefore, to further stimulate app adoption and use, its potential advantages and privacy-preserving mechanisms need to be stressed. Building further knowledge on the forms of resistance among nonusers is important for responding to these barriers through the app’s further development and communication campaigns. %M 34794117 %R 10.2196/22113 %U https://publichealth.jmir.org/2022/1/e22113 %U https://doi.org/10.2196/22113 %U http://www.ncbi.nlm.nih.gov/pubmed/34794117 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32587 %T Investigating the Use of Digital Health Technology to Monitor COVID-19 and Its Effects: Protocol for an Observational Study (Covid Collab Study) %A Stewart,Callum %A Ranjan,Yatharth %A Conde,Pauline %A Rashid,Zulqarnain %A Sankesara,Heet %A Bai,Xi %A Dobson,Richard J B %A Folarin,Amos A %+ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 20 7848 0924, amos.folarin@kcl.ac.uk %K mobile health %K COVID-19 %K digital health %K smartphone %K wearable devices %K mental health %K wearable %K data %K crowdsourced %K monitoring %K surveillance %K observational %K feasibility %K infectious disease %K recovery %K mobile phone %D 2021 %7 8.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The ubiquity of mobile phones and increasing use of wearable fitness trackers offer a wide-ranging window into people’s health and well-being. There are clear advantages in using remote monitoring technologies to gain an insight into health, particularly under the shadow of the COVID-19 pandemic. Objective: Covid Collab is a crowdsourced study that was set up to investigate the feasibility of identifying, monitoring, and understanding the stratification of SARS-CoV-2 infection and recovery through remote monitoring technologies. Additionally, we will assess the impacts of the COVID-19 pandemic and associated social measures on people’s behavior, physical health, and mental well-being. Methods: Participants will remotely enroll in the study through the Mass Science app to donate historic and prospective mobile phone data, fitness tracking wearable data, and regular COVID-19–related and mental health–related survey data. The data collection period will cover a continuous period (ie, both before and after any reported infections), so that comparisons to a participant’s own baseline can be made. We plan to carry out analyses in several areas, which will cover symptomatology; risk factors; the machine learning–based classification of illness; and trajectories of recovery, mental well-being, and activity. Results: As of June 2021, there are over 17,000 participants—largely from the United Kingdom—and enrollment is ongoing. Conclusions: This paper introduces a crowdsourced study that will include remotely enrolled participants to record mobile health data throughout the COVID-19 pandemic. The data collected may help researchers investigate a variety of areas, including COVID-19 progression; mental well-being during the pandemic; and the adherence of remote, digitally enrolled participants. International Registered Report Identifier (IRRID): DERR1-10.2196/32587 %M 34784292 %R 10.2196/32587 %U https://www.researchprotocols.org/2021/12/e32587 %U https://doi.org/10.2196/32587 %U http://www.ncbi.nlm.nih.gov/pubmed/34784292 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e30004 %T Using Venn Diagrams to Evaluate Digital Contact Tracing: Panel Survey Analysis %A Daniore,Paola %A Nittas,Vasileios %A Moser,André %A Höglinger,Marc %A von Wyl,Viktor %+ Institute for Implementation Science in Healthcare, University of Zurich, Universitätstrasse 84, Zurich, 8006, Switzerland, 41 446346380, viktor.vonwyl@uzh.ch %K digital contact tracing %K exposure notification %K COVID-19 %K SARS-CoV-2 %K contact tracing %K digital health %K tracing apps %K mHealth %K mobile apps %K key performance indicators %K Venn diagram approach %D 2021 %7 6.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Mitigation of the spread of infection relies on targeted approaches aimed at preventing nonhousehold interactions. Contact tracing in the form of digital proximity tracing apps has been widely adopted in multiple countries due to its perceived added benefits of tracing speed and breadth in comparison to traditional manual contact tracing. Assessments of user responses to exposure notifications through a guided approach can provide insights into the effect of digital proximity tracing app use on managing the spread of SARS-CoV-2. Objective: The aim of this study was to demonstrate the use of Venn diagrams to investigate the contributions of digital proximity tracing app exposure notifications and subsequent mitigative actions in curbing the spread of SARS-CoV-2 in Switzerland. Methods: We assessed data from 4 survey waves (December 2020 to March 2021) from a nationwide panel study (COVID-19 Social Monitor) of Swiss residents who were (1) nonusers of the SwissCovid app, (2) users of the SwissCovid app, or (3) users of the SwissCovid app who received exposure notifications. A Venn diagram approach was applied to describe the overlap or nonoverlap of these subpopulations and to assess digital proximity tracing app use and its associated key performance indicators, including actions taken to prevent SARS-CoV-2 transmission. Results: We included 12,525 assessments from 2403 participants, of whom 50.9% (1222/2403) reported not using the SwissCovid digital proximity tracing app, 49.1% (1181/2403) reported using the SwissCovid digital proximity tracing app and 2.5% (29/1181) of the digital proximity tracing app users reported having received an exposure notification. Most digital proximity tracing app users (75.9%, 22/29) revealed taking at least one recommended action after receiving an exposure notification, such as seeking SARS-CoV-2 testing (17/29, 58.6%) or calling a federal information hotline (7/29, 24.1%). An assessment of key indicators of mitigative actions through a Venn diagram approach reveals that 30% of digital proximity tracing app users (95% CI 11.9%-54.3%) also tested positive for SARS-CoV-2 after having received exposure notifications, which is more than 3 times that of digital proximity tracing app users who did not receive exposure notifications (8%, 95% CI 5%-11.9%). Conclusions: Responses in the form of mitigative actions taken by 3 out of 4 individuals who received exposure notifications reveal a possible contribution of digital proximity tracing apps in mitigating the spread of SARS-CoV-2. The application of a Venn diagram approach demonstrates its value as a foundation for researchers and health authorities to assess population-level digital proximity tracing app effectiveness by providing an intuitive approach for calculating key performance indicators. %M 34874890 %R 10.2196/30004 %U https://publichealth.jmir.org/2021/12/e30004 %U https://doi.org/10.2196/30004 %U http://www.ncbi.nlm.nih.gov/pubmed/34874890 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31271 %T Re-examining COVID-19 Self-Reported Symptom Tracking Programs in the United States: Updated Framework Synthesis %A Janvrin,Miranda Lynn %A Korona-Bailey,Jessica %A Koehlmoos,Tracey Pérez %+ The Henry M Jackson Foundation for the Advancement of Military Medicine, 6720B Rockledge Dr, Suite 100, Bethesda, MD, 20817, United States, 1 6035403059, miranda.janvrin@gmail.com %K COVID-19 %K coronavirus %K framework analysis %K information resources %K monitoring %K patient-reported outcome measures %K self-reported %K surveillance %K symptom tracking %K synthesis %K digital health %D 2021 %7 6.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Early in the pandemic, in 2020, Koehlmoos et al completed a framework synthesis of currently available self-reported symptom tracking programs for COVID-19. This framework described relevant programs, partners and affiliates, funding, responses, platform, and intended audience, among other considerations. Objective: This study seeks to update the existing framework with the aim of identifying developments in the landscape and highlighting how programs have adapted to changes in pandemic response. Methods: Our team developed a framework to collate information on current COVID-19 self-reported symptom tracking programs using the “best-fit” framework synthesis approach. All programs from the previous study were included to document changes. New programs were discovered using a Google search for target keywords. The time frame for the search for programs ranged from March 1, 2021, to May 6, 2021. Results: We screened 33 programs, of which 8 were included in our final framework synthesis. We identified multiple common data elements, including demographic information such as race, age, gender, and affiliation (all were associated with universities, medical schools, or schools of public health). Dissimilarities included questions regarding vaccination status, vaccine hesitancy, adherence to social distancing, COVID-19 testing, and mental health. Conclusions: At this time, the future of self-reported symptom tracking for COVID-19 is unclear. Some sources have speculated that COVID-19 may become a yearly occurrence much like the flu, and if so, the data that these programs generate is still valuable. However, it is unclear whether the public will maintain the same level of interest in reporting their symptoms on a regular basis if the prevalence of COVID-19 becomes more common. %M 34792469 %R 10.2196/31271 %U https://formative.jmir.org/2021/12/e31271 %U https://doi.org/10.2196/31271 %U http://www.ncbi.nlm.nih.gov/pubmed/34792469 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e28146 %T How Identification With the Social Environment and With the Government Guide the Use of the Official COVID-19 Contact Tracing App: Three Quantitative Survey Studies %A Scholl,Annika %A Sassenberg,Kai %+ Social Processes Lab, Leibniz-Institut fuer Wissensmedien, Schleichstr 6, Tuebingen, 72076, Germany, 49 7071979 ext 257, a.scholl@iwm-tuebingen.de %K COVID-19 %K SARS-CoV-2 %K contact tracing app %K social identification %K technology acceptance %K pandemic %K outbreak %K health technology %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Official contact tracing apps have been implemented and recommended for use across nations to track and contain the spread of COVID-19. Such apps can be effective if people are willing to use them. Accordingly, many attempts are being made to motivate citizens to make use of the officially recommended apps. Objective: The aim of this research was to contribute to an understanding of the preconditions under which people are willing to use a COVID-19 contact tracing app (ie, their use intentions and use). To go beyond personal motives in favor of app use, it is important to take people’s social relationships into account, under the hypothesis that the more people identify with the beneficiaries of app use (ie, people living close by in their social environment) and with the source recommending the app (ie, members of the government), the more likely they will be to accept the officially recommended contact tracing app. Methods: Before, right after, and 5 months after the official contact tracing app was launched in Germany, a total of 1044 people participated in three separate surveys. Structural equation modeling was used to test the hypotheses, examining the same model in all studies at these critical points in time. Results: Across the three surveys, both identification with the beneficiaries (people living in their social environment) and with the source recommending the app (members of the government) predicted greater intention to use and use (installation) of the official contact tracing app. Trust in the source (members of the government) served as a mediator. Other types of identification (with people in Germany or people around the world) did not explain the observed results. The findings were highly consistent across the three surveys. Conclusions: Attempts to motivate people to use new health technology (or potentially new measures more generally) not only for their personal benefit but also for collective benefits should take the social context into account (ie, the social groups people belong to and identify with). The more important the beneficiaries and the sources of such measures are to people’s sense of the self, the more willing they will likely be to adhere to and support such measures. %M 34662289 %R 10.2196/28146 %U https://mhealth.jmir.org/2021/11/e28146 %U https://doi.org/10.2196/28146 %U http://www.ncbi.nlm.nih.gov/pubmed/34662289 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e29181 %T To Use or Not to Use a COVID-19 Contact Tracing App: Mixed Methods Survey in Wales %A Jones,Kerina %A Thompson,Rachel %+ Swansea University, Population Data Science, Swansea University Medical School, Singleton Park, Swansea, SA28PP, United Kingdom, 44 01792602764, k.h.jones@swansea.ac.uk %K COVID-19 %K survey %K Wales %K contact tracing %K app %K mHealth %K mobile apps %K digital health %K public health %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many countries remain in the grip of the COVID-19 global pandemic, with a considerable journey still ahead toward normalcy and free mobility. Contact tracing smartphone apps are among a raft of measures introduced to reduce spread of the virus, but their uptake depends on public choice. Objective: The objective of this study was to ascertain the views of citizens in Wales on their intended use of a COVID-19 contact tracing smartphone app, including self-proposed reasons for or against use and what could lead to a change of decision. Methods: We distributed an anonymous survey among 4000 HealthWise Wales participants in May 2020. We adopted a mixed methods approach: responses to closed questions were analyzed using descriptive and inferential statistics; open question responses were analyzed and grouped into categories. Results: A total of 976 (24.4%) people completed the survey. Smartphone usage was 91.5% overall, but this varied among age groups. In total, 97.1% were aware of contact tracing apps, but only 67.2% felt sufficiently informed. Furthermore, 55.7% intended to use an app, 23.3% refused, and 21.0% were unsure. The top reasons for app use were as follows: controlling the spread of the virus, mitigating risks for others and for oneself, and increasing freedoms. The top reasons against app use were as follows: mistrusting the government, concerns about data security and privacy, and doubts about efficacy. The top response for changing one’s mind about app use from being willing to being unwilling was that nothing would; that is, they felt that nothing would cause them to become unwilling to use a contact tracing app. This was also the top response for changing one’s mind from being unwilling to being willing to use contact tracing apps. Among those who were unsure of using contact tracing apps, the top response was the need for more information. Conclusions: Respondents demonstrated a keenness to help themselves, others, society, and the government to avoid contracting the virus and to control its spread. However, digital inclusion varied among age groups, precluding participation for some people. Nonetheless, unwillingness was significant, and considering the nature of the concerns raised and the perceived lack of information, policy and decision-makers need to do more to act openly, increase communication, and demonstrate trustworthiness if members of the public are to be confident in using an app. %M 34698645 %R 10.2196/29181 %U https://mhealth.jmir.org/2021/11/e29181 %U https://doi.org/10.2196/29181 %U http://www.ncbi.nlm.nih.gov/pubmed/34698645 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e28956 %T Designing Better Exposure Notification Apps: The Role of Persuasive Design %A Oyibo,Kiemute %A Morita,Plinio Pelegrini %+ School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 41372, plinio.morita@uwaterloo.ca %K contact tracing app %K exposure notification app %K COVID Alert %K COVID-19 %K persuasive technology %K behavior change %D 2021 %7 16.11.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Background: Digital contact tracing apps have been deployed worldwide to limit the spread of COVID-19 during this pandemic and to facilitate the lifting of public health restrictions. However, due to privacy-, trust-, and design-related issues, the apps are yet to be widely adopted. This calls for an intervention to enable a critical mass of users to adopt them. Objective: The aim of this paper is to provide guidelines to design contact tracing apps as persuasive technologies to make them more appealing and effective. Methods: We identified the limitations of the current contact tracing apps on the market using the Government of Canada’s official exposure notification app (COVID Alert) as a case study. Particularly, we identified three interfaces in the COVID Alert app where the design can be improved. The interfaces include the no exposure status interface, exposure interface, and diagnosis report interface. We propose persuasive technology design guidelines to make them more motivational and effective in eliciting the desired behavior change. Results: Apart from trust and privacy concerns, we identified the minimalist and nonmotivational design of exposure notification apps as the key design-related factors that contribute to the current low uptake. We proposed persuasive strategies such as self-monitoring of daily contacts and exposure time to make the no exposure and exposure interfaces visually appealing and motivational. Moreover, we proposed social learning, praise, and reward to increase the diagnosis report interface’s effectiveness. Conclusions: We demonstrated that exposure notification apps can be designed as persuasive technologies by incorporating key persuasive features, which have the potential to improve uptake, use, COVID-19 diagnosis reporting, and compliance with social distancing guidelines. %M 34783673 %R 10.2196/28956 %U https://publichealth.jmir.org/2021/11/e28956 %U https://doi.org/10.2196/28956 %U http://www.ncbi.nlm.nih.gov/pubmed/34783673 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e30462 %T The Influence of Normative Perceptions on the Uptake of the COVID-19 TraceTogether Digital Contact Tracing System: Cross-sectional Study %A Lee,Jeong Kyu %A Lin,Lavinia %A Kang,Hyunjin %+ Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 10-01, Singapore, 117549, Singapore, 65 66015838, lee.jeongkyu@gmail.com %K COVID-19 %K social norms %K TraceTogether %K Singapore %K contact tracing %K mobile app %K token %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In 2020, the Singapore government rolled out the TraceTogether program, a digital system to facilitate contact tracing efforts in response to the COVID-19 pandemic. This system is available as a smartphone app and Bluetooth-enabled token to help identify close contacts. As of February 1, 2021, more than 80% of the population has either downloaded the mobile app or received the token in Singapore. Despite the high adoption rate of the TraceTogether mobile app and token (ie, device), it is crucial to understand the role of social and normative perceptions in uptake and usage by the public, given the collective efforts for contact tracing. Objective: This study aimed to examine normative influences (descriptive and injunctive norms) on TraceTogether device use for contact tracing purposes, informed by the theory of normative social behavior, a theoretical framework to explain how perceived social norms are related to behaviors. Methods: From January to February 2021, cross-sectional data were collected by a local research company through emailing their panel members who were (1) Singapore citizens or permanent residents aged 21 years or above; (2) able to read English; and (3) internet users with access to a personal email account. The study sample (n=1137) was restricted to those who had either downloaded the TraceTogether mobile app or received the token. Results: Multivariate (linear and ordinal logistic) regression analyses were carried out to assess the relationships of the behavioral outcome variables (TraceTogether device usage and intention of TraceTogether device usage) with potential correlates, including perceived social norms, perceived community, and interpersonal communication. Multivariate regression analyses indicated that descriptive norms (unstandardized regression coefficient β=0.31, SE=0.05; P<.001) and injunctive norms (unstandardized regression coefficient β=0.16, SE=0.04; P<.001) were significantly positively associated with the intention to use the TraceTogether device. It was also found that descriptive norms were a significant correlate of TraceTogether device use frequency (adjusted odds ratio [aOR] 2.08, 95% CI 1.66-2.61; P<.001). Though not significantly related to TraceTogether device use frequency, injunctive norms moderated the relationship between descriptive norms and the outcome variable (aOR 1.12, 95% CI 1.03-1.21; P=.005). Conclusions: This study provides useful implications for the design of effective intervention strategies to promote the uptake and usage of digital methods for contact tracing in a multiethnic Asian population. Our findings highlight that influence from social networks plays an important role in developing normative perceptions in relation to TraceTogether device use for contact tracing. To promote the uptake of the TraceTogether device and other preventive behaviors for COVID-19, it would be useful to devise norm-based interventions that address these normative perceptions by presenting high prevalence and approval of important social referents, such as family and close friends. %M 34623956 %R 10.2196/30462 %U https://publichealth.jmir.org/2021/11/e30462 %U https://doi.org/10.2196/30462 %U http://www.ncbi.nlm.nih.gov/pubmed/34623956 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e32093 %T Mobile Apps Leveraged in the COVID-19 Pandemic in East and South-East Asia: Review and Content Analysis %A Lee,Bohee %A Ibrahim,Siti Aishah %A Zhang,Tiying %+ Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 1316503034, bohee.lee@ed.ac.uk %K mobile apps %K applications %K eHealth %K mHealth %K mobile health %K digital health %K telemedicine %K telehealth %K COVID-19 %K coronavirus %K pandemic %K public health %K health policy %D 2021 %7 11.11.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic increased attention to digital tools to support governmental public health policies in East and South-East Asia. Mobile apps related to the COVID-19 pandemic continue to emerge and evolve with a wide variety of characteristics and functions. However, there is a paucity of studies evaluating such apps in this region, with most of the available studies conducted in the early days of the pandemic. Objective: This study aimed to examine free apps developed or supported by governments in the East and South-East Asian region and highlight their key characteristics and functions. We also sought to interpret how the release dates of these apps were related to the commencement dates of other COVID-19 public health policies. Methods: We systematically searched for apps in Apple App Store and Google Play Store and analyzed the contents of eligible apps. Mobile apps released or updated with COVID-19–related functions between March 1 and May 7, 2021, in Singapore, Taiwan, South Korea, China (mainland), Japan, Thailand, Hong Kong, Vietnam, Malaysia, Indonesia, and the Philippines were included. The CoronaNet Research Project database was also examined to determine the timeline of public health policy commencement dates in relation to the release dates of the included apps. We assessed each app’s official website, media reports, and literature through content analysis. Descriptive statistics were used to summarize relevant information gathered from the mobile apps using RStudio. Results: Of the 1943 mobile apps initially identified, 46 were eligible, with almost 70% of the apps being intended for the general public. Most apps were from Vietnam (n=9, 20%), followed by Malaysia, Singapore, and Thailand (n=6 each, 13%). Of note, most apps for quarantine monitoring (n=6, 13%) were mandatory for the target users or a population subset. The most common function was health monitoring (32/46, 70%), followed by raising public health awareness (19/46, 41%) through education and information dissemination. Other functions included monitoring quarantine (12/46, 26%), providing health resources (12/46, 26%). COVID-19 vaccination management functions began to appear in parallel with vaccine rollout (7/46, 15%). Regarding the timing of the introduction of mobile solutions, the majority of mobile apps emerged close to the commencement dates of other public health policies in the early stages of the pandemic between March and April 2020. Conclusions: In East and South-East Asia, most governments used mobile health apps as adjuncts to public health measures for tracking COVID-19 cases and delivering credible information. In addition, these apps have evolved by expanding their functions for COVID-19 vaccination. %M 34748515 %R 10.2196/32093 %U https://mhealth.jmir.org/2021/11/e32093 %U https://doi.org/10.2196/32093 %U http://www.ncbi.nlm.nih.gov/pubmed/34748515 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27301 %T Positioning Digital Tracing Applications in the Management of the COVID-19 Pandemic in France %A Albouy-Llaty,Marion %A Martin,Caroline %A Benamouzig,Daniel %A Bothorel,Eric %A Munier,Gilles %A Simonin,Catherine %A Guéant,Jean-Louis %A Rusch,Emmanuel %+ Faculty of Medicine and Pharmacy, University of Poitiers, 6 rue de la Milétrie, Poitiers, 86021, France, 33 0669660192, marion.albouy@univ-poitiers.fr %K COVID-19 pandemic %K digital contact tracing applications %K health inequalities %K Europe %K health promotion %D 2021 %7 7.10.2021 %9 Viewpoint %J J Med Internet Res %G English %X To combat the COVID-19 pandemic, many European countries have developed a public health strategy involving the use of digital contact tracing (DCT) applications to improve timely tracking and contact tracing of COVID-19 cases. France’s independent COVID-19 Control and Society Connection Council (CCL) was established by law in May 2020 to issue advice and recommendations on the national epidemic digital systems. In this paper, we present the recommendations by the CCL, with the objective to increase the uptake and utility of French DCT applications. As the country's most vulnerable population has been subjected to greater virus exposure, a stronger impact of the lockdown, and less access to preventive and health care services, the CCL is particularly aware of health inequalities. The French DCT app TousAntiCovid had been downloaded by 13.6 million users (ie, 20% of the French population) in March 2021. To promote the use of DCT apps, the CCL has recommended that communication about the app’s individual and collective objectives be increased. The CCL has also recommended the introduction of clear, simple, accessible, incentivizing, noncoercive information within the digital tools. In addition, the CCL has recommended improving public health policies to address the needs of the underprivileged. The CCL calls for promoting population empowerment with the use of digital tools, improving public health culture for decision-makers dealing with health determinants, taking social considerations into account, and incorporating community participation. %M 34313588 %R 10.2196/27301 %U https://www.jmir.org/2021/10/e27301 %U https://doi.org/10.2196/27301 %U http://www.ncbi.nlm.nih.gov/pubmed/34313588 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30444 %T Detection of Spatiotemporal Clusters of COVID-19–Associated Symptoms and Prevention Using a Participatory Surveillance App: Protocol for the @choum Study %A De Ridder,David %A Loizeau,Andrea Jutta %A Sandoval,José Luis %A Ehrler,Frédéric %A Perrier,Myriam %A Ritch,Albert %A Violot,Guillemette %A Santolini,Marc %A Greshake Tzovaras,Bastian %A Stringhini,Silvia %A Kaiser,Laurent %A Pradeau,Jean-François %A Joost,Stéphane %A Guessous,Idris %+ Division of Primary Care, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, Geneva, 1205, Switzerland, 41 22 305 58 61, Idris.Guessous@hcuge.ch %K participatory surveillance %K infectious disease %K COVID-19 %K SARS-CoV-2 %K space-time clustering %K digital health %K mobile app %K mHealth %K epidemiology %K surveillance %K digital surveillance %K public health %D 2021 %7 6.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The early detection of clusters of infectious diseases such as the SARS-CoV-2–related COVID-19 disease can promote timely testing recommendation compliance and help to prevent disease outbreaks. Prior research revealed the potential of COVID-19 participatory syndromic surveillance systems to complement traditional surveillance systems. However, most existing systems did not integrate geographic information at a local scale, which could improve the management of the SARS-CoV-2 pandemic. Objective: The aim of this study is to detect active and emerging spatiotemporal clusters of COVID-19–associated symptoms, and to examine (a posteriori) the association between the clusters’ characteristics and sociodemographic and environmental determinants. Methods: This report presents the methodology and development of the @choum (English: “achoo”) study, evaluating an epidemiological digital surveillance tool to detect and prevent clusters of individuals (target sample size, N=5000), aged 18 years or above, with COVID-19–associated symptoms living and/or working in the canton of Geneva, Switzerland. The tool is a 5-minute survey integrated into a free and secure mobile app (CoronApp-HUG). Participants are enrolled through a comprehensive communication campaign conducted throughout the 12-month data collection phase. Participants register to the tool by providing electronic informed consent and nonsensitive information (gender, age, geographically masked addresses). Symptomatic participants can then report COVID-19–associated symptoms at their onset (eg, symptoms type, test date) by tapping on the @choum button. Those who have not yet been tested are offered the possibility to be informed on their cluster status (information returned by daily automated clustering analysis). At each participation step, participants are redirected to the official COVID-19 recommendations websites. Geospatial clustering analyses are performed using the modified space-time density-based spatial clustering of applications with noise (MST-DBSCAN) algorithm. Results: The study began on September 1, 2020, and will be completed on February 28, 2022. Multiple tests performed at various time points throughout the 5-month preparation phase have helped to improve the tool’s user experience and the accuracy of the clustering analyses. A 1-month pilot study performed among 38 pharmacists working in 7 Geneva-based pharmacies confirmed the proper functioning of the tool. Since the tool’s launch to the entire population of Geneva on February 11, 2021, data are being collected and clusters are being carefully monitored. The primary study outcomes are expected to be published in mid-2022. Conclusions: The @choum study evaluates an innovative participatory epidemiological digital surveillance tool to detect and prevent clusters of COVID-19–associated symptoms. @choum collects precise geographic information while protecting the user’s privacy by using geomasking methods. By providing an evidence base to inform citizens and local authorities on areas potentially facing a high COVID-19 burden, the tool supports the targeted allocation of public health resources and promotes testing. International Registered Report Identifier (IRRID): DERR1-10.2196/30444 %M 34449403 %R 10.2196/30444 %U https://www.researchprotocols.org/2021/10/e30444 %U https://doi.org/10.2196/30444 %U http://www.ncbi.nlm.nih.gov/pubmed/34449403 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30339 %T A Guided Internet-Based Problem-Solving Intervention Delivered Through Smartphones for Secondary School Pupils During the COVID-19 Pandemic in India: Protocol for a Pilot Randomized Controlled Trial %A Gonsalves,Pattie P %A Sharma,Rhea %A Hodgson,Eleanor %A Bhat,Bhargav %A Jambhale,Abhijeet %A Weiss,Helen A %A Fairburn,Christopher G %A Cavanagh,Kate %A Cuijpers,Pim %A Michelson,Daniel %A Patel,Vikram %+ Sangath, E-5, Lane 1, Westend Marg, Saiyad ul ajaib, Saket, New Delhi, 110030, India, 91 9899419704, pattie.gonsalves@sangath.in %K randomized controlled trial %K internet-based intervention %K smartphone %K adolescent %K schools %K mental health %K COVID-19 %K app %K protocol %K problem-solving %K intervention %K teenager %K young adult %K India %K feasibility %K effective %D 2021 %7 6.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: “POD Adventures” is a gamified mental health intervention delivered via a smartphone app and supported by counsellors for a target population of secondary school students in India. This paper describes the protocol for a pilot randomized controlled trial of a remotely delivered version of the intervention in the context of COVID-19 restrictions. Objective: Our objectives are to assess the feasibility of research procedures and intervention delivery and to generate preliminary estimates of the effectiveness of the intervention to inform the sample size calculation of a full-scale trial. Methods: We will conduct a parallel, 2-arm, individually randomized pilot controlled trial in 11 secondary schools in Goa, India. This pilot trial aims to recruit 70 participants with a felt need for psychological support. Participants will receive either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes will be assessed at two timepoints: baseline and 6 weeks post randomization. Results: The first participant was enrolled on January 28, 2021, and 6-week assessment completed on April 4, 2021. Owing to a second wave of the COVID-19 pandemic in India, schools in Goa were closed on April 22, 2021. Trial participants are currently receiving the intervention or completing follow-up assessments. Conclusions: This pilot trial will help understand the feasibility of implementing and evaluating a remotely delivered digital mental health intervention in a low-resource setting. Our findings will be used to design future trials that can address difficulties of accessing psychosocial support in-person and support wider efforts to scale up evidence-based mental health interventions for young people. Trial Registration: ClinicalTrials.gov NCT04672486; https://clinicaltrials.gov/ct2/show/NCT04672486 International Registered Report Identifier (IRRID): DERR1-10.2196/30339 %M 34586075 %R 10.2196/30339 %U https://www.researchprotocols.org/2021/10/e30339 %U https://doi.org/10.2196/30339 %U http://www.ncbi.nlm.nih.gov/pubmed/34586075 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e30871 %T Post-COVID Public Health Surveillance and Privacy Expectations in the United States: Scenario-Based Interview Study %A Seberger,John S %A Patil,Sameer %+ College of Communication Arts & Sciences, Michigan State University, 404 Wilson Rd, East Lansing, MI, 48824, United States, 1 (517) 416 0743, seberge1@msu.edu %K COVID-19 %K pandemic-tracking apps %K privacy concerns %K infrastructure %K health surveillance %K scenario %K interview %K thematic analysis %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-based apps designed and deployed to mitigate the COVID-19 pandemic may become infrastructure for postpandemic public health surveillance in the United States. Through the lenses of privacy concerns and user expectations of digital pandemic mitigation techniques, we identified possible long-term sociotechnical implications of such an infrastructure. Objective: We explored how people in the United States perceive the possible routinization of pandemic tracking apps for public health surveillance in general. Our interdisciplinary analysis focused on the interplay between privacy concerns, data practices of surveillance capitalism, and trust in health care providers. We conducted this analysis to achieve a richer understanding of the sociotechnical issues raised by the deployment and use of technology for pandemic mitigation. Methods: We conducted scenario-based, semistructured interviews (n=19) with adults in the United States. The interviews focused on how people perceive the short- and long-term privacy concerns associated with a fictional smart thermometer app deployed to mitigate the “outbreak of a contagious disease.” In order to elicit future-oriented discussions, the scenario indicated that the app would continue functioning “after the disease outbreak has dissipated.” We analyzed interview transcripts using reflexive thematic analysis. Results: In the context of pandemic mitigation technology, including app-based tracking, people perceive a core trade-off between public health and personal privacy. People tend to rationalize this trade-off by invoking the concept of “the greater good.” The interplay between the trade-off and rationalization forms the core of sociotechnical issues that pandemic mitigation technologies raise. Participants routinely expected that data collected through apps related to public health would be shared with unknown third parties for the financial gain of the app makers. This expectation suggests a perceived alignment between an app-based infrastructure for public health surveillance and the broader economics of surveillance capitalism. Our results highlight unintended and unexpected sociotechnical impacts of routinizing app-based tracking on postpandemic life, which are rationalized by invoking a nebulous concept of the greater good. Conclusions: While technologies such as app-based tracking could be useful for pandemic mitigation and preparedness, the routinization of such apps as a form of public health surveillance may have broader, unintentional sociotechnical implications for individuals and the societies in which they live. Although technology has the potential to increase the efficacy of pandemic mitigation, it exists within a broader network of sociotechnical concerns. Therefore, it is necessary to consider the long-term implications of pandemic mitigation technologies beyond the immediate needs of addressing the COVID-19 pandemic. Potential negative consequences include the erosion of patient trust in health care systems and providers, grounded in concerns about privacy violations and overly broad surveillance. %M 34519667 %R 10.2196/30871 %U https://mhealth.jmir.org/2021/10/e30871 %U https://doi.org/10.2196/30871 %U http://www.ncbi.nlm.nih.gov/pubmed/34519667 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29085 %T Public Adoption of and Trust in the NHS COVID-19 Contact Tracing App in the United Kingdom: Quantitative Online Survey Study %A Dowthwaite,Liz %A Fischer,Joel %A Perez Vallejos,Elvira %A Portillo,Virginia %A Nichele,Elena %A Goulden,Murray %A McAuley,Derek %+ Horizon Digital Economy Research, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 07943583035, liz.dowthwaite@gmail.com %K trust %K technology adoption %K COVID-19 %K digital contact tracing %K coronavirus %K vulnerable populations %K attitudes %K SARS-CoV-2 %K digital proximity tracing %K compliance %D 2021 %7 17.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital contact tracing is employed to monitor and manage the spread of COVID-19. However, to be effective the system must be adopted by a substantial proportion of the population. Studies of mostly hypothetical contact tracing apps show generally high acceptance, but little is known about the drivers and barriers to adoption of deployed systems. Objective: The aim of this study was to investigate adoption of and attitudes toward the NHS (National Health Service) COVID-19 smartphone app, the digital contact tracing solution in the United Kingdom. Methods: An online survey based on the extended Technology Acceptance Model with the added factor of trust was carried out with a representative sample of the UK population. Statistical analysis showed adoption rates, attitudes toward and trust in the app, and compliance with self-isolation advice and highlighted differences for vulnerable populations (ie, older adults aged 65 years and over and members of Black, Asian, and minority ethnic [BAME] communities). Results: A total of 1001 participants took part in the study. Around half of the participants who had heard of the NHS COVID-19 mobile phone app (490/963, 50.9%; 95% CI 47.8%-54.0%) had downloaded and kept the app, but more than one-third (345/963, 35.8%; 95% CI 32.8%-38.8%) either did not intend to download it or had deleted it. Significantly more BAME respondents than White respondents had deleted the app (16/115, 13.9%; 95% CI 11.8%-16.0%, vs 65/876, 7.4%; 95% CI 5.8%-9.0%), and significantly more older adults 65 years and over than those under 65 years did not intend to download it (44/127, 34.6%; 95% CI 31.7%-37.5%, vs 220/874, 25.2%; 95% CI 22.5%-27.9%). Broadly, one of the reasons for uptake was to help the NHS and other people, especially among older adults, although significantly fewer BAME participants agreed that they did so to help the NHS. Reported compliance with received notifications to self-isolate was high but was significantly lower than reported intended compliance without received notifications. Only one-fifth (136/699, 19.5%; 95% CI 17.0%-22.0%) of participants understood that the decision to send self-isolation notifications was automated by the app. There were a range of significantly more negative views among BAME participants, including lower trust in the NHS, while older adults were often significantly more positive. Respondents without the app reported significantly lower trust and more negative views toward the app and were less likely to report that they understood how the app works. Conclusions: 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. This study highlights that more needs to be done to improve adoption among groups who are more vulnerable to the effects of the virus in order to enhance uptake and acceptance of contact tracing apps. %M 34406960 %R 10.2196/29085 %U https://www.jmir.org/2021/9/e29085 %U https://doi.org/10.2196/29085 %U http://www.ncbi.nlm.nih.gov/pubmed/34406960 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30819 %T Early Detection of Symptom Exacerbation in Patients With SARS-CoV-2 Infection Using the Fitbit Charge 3 (DEXTERITY): Pilot Evaluation %A Yamagami,Kan %A Nomura,Akihiro %A Kometani,Mitsuhiro %A Shimojima,Masaya %A Sakata,Kenji %A Usui,Soichiro %A Furukawa,Kenji %A Takamura,Masayuki %A Okajima,Masaki %A Watanabe,Kazuyoshi %A Yoneda,Takashi %+ Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Japan, 81 076 265 2000, anomura@med.kanazawa-u.ac.jp %K COVID-19 %K silent hypoxia %K wearable device %K Fitbit %K estimated oxygen variation %K detection %K infectious disease %K pilot study %K symptom %K outpatient %K oxygen %K sleep %K wearable %D 2021 %7 16.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Some patients with COVID-19 experienced sudden death due to rapid symptom deterioration. Thus, it is important to predict COVID-19 symptom exacerbation at an early stage prior to increasing severity in patients. Patients with COVID-19 could experience a unique “silent hypoxia” at an early stage of the infection when they are apparently asymptomatic, but with rather low SpO2 (oxygen saturation) levels. In order to continuously monitor SpO2 in daily life, a high-performance wearable device, such as the Apple Watch or Fitbit, has become commercially available to monitor several biometric data including steps, resting heart rate (RHR), physical activity, sleep quality, and estimated oxygen variation (EOV). Objective: This study aimed to test whether EOV measured by the wearable device Fitbit can predict COVID-19 symptom exacerbation. Methods: We recruited patients with COVID-19 from August to November 2020. Patients were asked to wear the Fitbit for 30 days, and biometric data including EOV and RHR were extracted. EOV is a relative physiological measure that reflects users’ SpO2 levels during sleep. We defined a high EOV signal as a patient’s oxygen level exhibiting a significant dip and recovery within the index period, and a high RHR signal as daily RHR exceeding 5 beats per day compared with the minimum RHR of each patient in the study period. We defined successful prediction as the appearance of those signals within 2 days before the onset of the primary outcome. The primary outcome was the composite of deaths of all causes, use of extracorporeal membrane oxygenation, use of mechanical ventilation, oxygenation, and exacerbation of COVID-19 symptoms, irrespective of readmission. We also assessed each outcome individually as secondary outcomes. We made weekly phone calls to discharged patients to check on their symptoms. Results: We enrolled 23 patients with COVID-19 diagnosed by a positive SARS-CoV-2 polymerase chain reaction test. The patients had a mean age of 50.9 (SD 20) years, and 70% (n=16) were female. Each patient wore the Fitbit for 30 days. COVID-19 symptom exacerbation occurred in 6 (26%) patients. We were successful in predicting exacerbation using EOV signals in 4 out of 5 cases (sensitivity=80%, specificity=90%), whereas the sensitivity and specificity of high RHR signals were 50% and 80%, respectively, both lower than those of high EOV signals. Coincidental obstructive sleep apnea syndrome confirmed by polysomnography was detected in 1 patient via consistently high EOV signals. Conclusions: This pilot study successfully detected early COVID-19 symptom exacerbation by measuring EOV, which may help to identify the early signs of COVID-19 exacerbation. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000041421; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047290 %M 34516390 %R 10.2196/30819 %U https://formative.jmir.org/2021/9/e30819 %U https://doi.org/10.2196/30819 %U http://www.ncbi.nlm.nih.gov/pubmed/34516390 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e26318 %T User Experiences of the NZ COVID Tracer App in New Zealand: Thematic Analysis of Interviews %A Tretiakov,Alexei %A Hunter,Inga %+ School of Management, Massey University, Tennent Drive, Palmerston North, 4474, New Zealand, 64 6 951 7905, A.Tretiakov@massey.ac.nz %K COVID-19 %K contact tracing %K app %K New Zealand %K adoption %K use %K civic responsibility %K privacy %D 2021 %7 8.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: For mobile app–based COVID-19 contact tracing to be fully effective, a large majority of the population needs to be using the app on an ongoing basis. However, there is a paucity of studies of users, as opposed to potential adopters, of mobile contact tracing apps and of their experiences. New Zealand, a high-income country with western political culture, was successful in managing the COVID-19 pandemic, and its experience is valuable for informing policy responses in similar contexts. Objective: This study asks the following research questions: (1) How do users experience the app in their everyday contexts? and (2) What drives the use of the app? Methods: Residents of New Zealand’s Auckland region, which encompasses the country’s largest city, were approached via Facebook, and 34 NZ COVID Tracer app users were interviewed. Interview transcripts were analyzed using thematic analysis. Results: Interviews ranged in duration from 15 to 50 minutes. Participants ranged in age from those in their late teens to those in their early sixties. Even though about half of the participants identified as White New Zealanders of European origin, different ethnicities were represented, including New Zealanders of South Pacific, Indian, Middle Eastern, South American, and Southeast Asian descent. Out of 34 participants, 2 (6%) identified as Māori (Indigenous New Zealanders). A broad range of careers were represented, from top-middle management to health support work and charity work. Likewise, educational backgrounds ranged broadly, from high school completion to master’s degrees. Out of 34 participants, 2 (6%) were unemployed, having recently lost their jobs because of the pandemic. The thematic analysis resulted in five major themes: perceived benefits, patterns of use, privacy, social influence, and need for collective action. Benefits of using the app to society in general were more salient to the participants than immediate health benefits to the individual. Use, however, depended on the alert level and tended to decline for many participants at low alert levels. Privacy considerations played a small role in shaping adoption and use, even though the participants were highly aware of privacy discourse around the app. Participants were aware of the need for high levels of adoption and use of the app to control the pandemic. Attempts to encourage others to use the app were common, although not always successful. Conclusions: Appeals to civic responsibility are likely to drive the use of a mobile contact tracing app under the conditions of high threat. Under the likely scenario of COVID-19 remaining endemic and requiring ongoing vigilance over the long term, other mechanisms promoting the use of mobile contact tracing apps may be needed, such as offering incentives. As privacy is not an important concern for many users, flexible privacy settings in mobile contact tracing apps allowing users to set their optimal levels of privacy may be appropriate. %M 34292868 %R 10.2196/26318 %U https://mhealth.jmir.org/2021/9/e26318 %U https://doi.org/10.2196/26318 %U http://www.ncbi.nlm.nih.gov/pubmed/34292868 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 8 %P e29923 %T Prosociality and the Uptake of COVID-19 Contact Tracing Apps: Survey Analysis of Intergenerational Differences in Japan %A Shoji,Masahiro %A Ito,Asei %A Cato,Susumu %A Iida,Takashi %A Ishida,Kenji %A Katsumata,Hiroto %A McElwain,Kenneth Mori %+ Institute of Social Science, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 3 5841 4927, shoji@iss.u-tokyo.ac.jp %K COVID-19 %K contact tracing app %K place attachment %K place identity %K contact tracing %K pandemic %K mHealth %K health policy %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To control the COVID-19 pandemic, it is essential to trace and contain infection chains; for this reason, policymakers have endorsed the usage of contact tracing apps. To date, over 50 countries have released such apps officially or semiofficially, but those that rely on citizens’ voluntary uptake suffer from low adoption rates, reducing their effectiveness. Early studies suggest that the low uptake is driven by citizens’ concerns about security and privacy, as well as low perceptions of infection risk and benefits from the usage. However, these do not explore important generational differences in uptake decision or the association between individuals’ prosociality and uptake. Objective: The objective of our study was to examine the role of individuals’ prosociality and other factors discussed in the literature, such as perceived risk and trust in government, in encouraging the usage of contact tracing apps in Japan. We paid particular attention to generational differences. Methods: A web-based survey was conducted in Japan 6 months after the release of a government-sponsored contact tracing app. Participants were recruited from individuals aged between 20 and 69 years. Exploratory factor analyses were conducted to measure prosociality, risk perception, and trust in government. Logistic regression was used to examine the association between these factors and uptake. Results: There was a total of 7084 respondents, and observations from 5402 respondents were used for analysis, of which 791 respondents (14.6%) had ever used the app. Two factors of prosociality were retained: agreeableness and attachment to the community. Full-sample analysis demonstrated app uptake was determined by agreeableness, attachment to the community, concern about health risks, concern about social risks, and trust in the national government; however, important differences existed. The uptake decision of respondents aged between 20 and 39 years was attributed to their attachment to the community (odds ratio [OR] 1.28, 95% CI 1.11-1.48). Agreeable personality (OR 1.18, 95% CI 1.02-1.35), concern about social risk (OR 1.17, 95% CI 1.02-1.35), and trust in national government (OR 1.16, 95% CI 1.05-1.28) were key determinants for those aged between 40 and 59 years. For those aged over 60 years, concerns about health risks determined the uptake decision (OR 1.49, 95% CI 1.24-1.80). Conclusions: Policymakers should implement different interventions for each generation to increase the adoption rate of contact tracing apps. It may be effective to inform older adults about the health benefits of the apps. For middle-age adults, it is important to mitigate concerns about security and privacy issues, and for younger generations, it is necessary to boost their attachment to their community by utilizing social media and other web-based network tools. %M 34313601 %R 10.2196/29923 %U https://mhealth.jmir.org/2021/8/e29923 %U https://doi.org/10.2196/29923 %U http://www.ncbi.nlm.nih.gov/pubmed/34313601 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e29268 %T Self-Focused and Other-Focused Health Concerns as Predictors of the Uptake of Corona Contact Tracing Apps: Empirical Study %A große Deters,Fenne %A Meier,Tabea %A Milek,Anne %A Horn,Andrea B %+ Weizenbaum Institute for the Networked Society, Hardenbergstraße 32, Berlin, 10623, Germany, 49 331977 3710, fenne.grosse.deters@uni-potsdam.de %K COVID-19 %K corona contact tracing app %K digital proximity tracing %K preventive behavior %K health concern %K prosocial motivation %K public health %K risk perception, eHealth, Corona-Warn-App %K SwissCovid %K contact tracing app %K contact tracing %D 2021 %7 10.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Corona contact tracing apps are a novel and promising measure to reduce the spread of COVID-19. They can help to balance the need to maintain normal life and economic activities as much as possible while still avoiding exponentially growing case numbers. However, a majority of citizens need to be willing to install such an app for it to be effective. Hence, knowledge about drivers for app uptake is crucial. Objective: This study aimed to add to our understanding of underlying psychological factors motivating app uptake. More specifically, we investigated the role of concern for one’s own health and concern to unknowingly infect others. Methods: A two-wave survey with 346 German-speaking participants from Switzerland and Germany was conducted. We measured the uptake of two decentralized contact tracing apps officially launched by governments (Corona-Warn-App, Germany; SwissCovid, Switzerland), as well as concerns regarding COVID-19 and control variables. Results: Controlling for demographic variables and general attitudes toward the government and the pandemic, logistic regression analysis showed a significant effect of self-focused concerns (odds ratio [OR] 1.64, P=.002). Meanwhile, concern of unknowingly infecting others did not contribute significantly to the prediction of app uptake over and above concern for one’s own health (OR 1.01, P=.92). Longitudinal analyses replicated this pattern and showed no support for the possibility that app uptake provokes changes in levels of concern. Testing for a curvilinear relationship, there was no evidence that “too much” concern leads to defensive reactions and reduces app uptake. Conclusions: As one of the first studies to assess the installation of already launched corona tracing apps, this study extends our knowledge of the motivational landscape of app uptake. Based on this, practical implications for communication strategies and app design are discussed. %M 34227995 %R 10.2196/29268 %U https://www.jmir.org/2021/8/e29268 %U https://doi.org/10.2196/29268 %U http://www.ncbi.nlm.nih.gov/pubmed/34227995 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28947 %T Evaluating Epidemiological Risk by Using Open Contact Tracing Data: Correlational Study %A Piotto,Stefano %A Di Biasi,Luigi %A Marrafino,Francesco %A Concilio,Simona %+ Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, Fisciano, 84084, Italy, 39 3204230068, piotto@unisa.it %K SARS-CoV-2 %K COVID-19 %K contact tracing %K Bluetooth Low Energy %K transmission dynamics %K infection spread %K mobile apps %K mHealth %K digital apps %K mobile phone %D 2021 %7 2.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the 2020s, there has been extensive debate about the possibility of using contact tracing (CT) to contain the SARS-CoV-2 pandemic, and concerns have been raised about data security and privacy. Little has been said about the effectiveness of CT. In this paper, we present a real data analysis of a CT experiment that was conducted in Italy for 8 months and involved more than 100,000 CT app users. Objective: We aimed to discuss the technical and health aspects of using a centralized approach. We also aimed to show the correlation between the acquired contact data and the number of SARS-CoV-2–positive cases. Finally, we aimed to analyze CT data to define population behaviors and show the potential applications of real CT data. Methods: We collected, analyzed, and evaluated CT data on the duration, persistence, and frequency of contacts over several months of observation. A statistical test was conducted to determine whether there was a correlation between indices of behavior that were calculated from the data and the number of new SARS-CoV-2 infections in the population (new SARS-CoV-2–positive cases). Results: We found evidence of a correlation between a weighted measure of contacts and the number of new SARS-CoV-2–positive cases (Pearson coefficient=0.86), thereby paving the road to better and more accurate data analyses and spread predictions. Conclusions: Our data have been used to determine the most relevant epidemiological parameters and can be used to develop an agent-based system for simulating the effects of restrictions and vaccinations. Further, we demonstrated our system's ability to identify the physical locations where the probability of infection is the highest. All the data we collected are available to the scientific community for further analysis. %M 34227997 %R 10.2196/28947 %U https://www.jmir.org/2021/8/e28947 %U https://doi.org/10.2196/28947 %U http://www.ncbi.nlm.nih.gov/pubmed/34227997 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e30709 %T Online-Delivered Group and Personal Exercise Programs to Support Low Active Older Adults’ Mental Health During the COVID-19 Pandemic: Randomized Controlled Trial %A Beauchamp,Mark R %A Hulteen,Ryan M %A Ruissen,Geralyn R %A Liu,Yan %A Rhodes,Ryan E %A Wierts,Colin M %A Waldhauser,Katrina J %A Harden,Samantha H %A Puterman,Eli %+ School of Kinesiology, University of British Columbia, 6081 University Blvd, Vancouver, BC, V6T 1Z1, Canada, 1 604 822 4864, mark.beauchamp@ubc.ca %K COVID-19 %K randomized trial %K mental health %K physical activity %D 2021 %7 30.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In response to the COVID-19 pandemic, experts in mental health science emphasized the importance of developing and evaluating approaches to support and maintain the mental health of older adults. Objective: The aim of this study was to assess whether a group-based exercise program relative to a personal exercise program (both delivered online) and waitlist control (WLC) can improve the psychological health of previously low active older adults during the early stages of the COVID-19 pandemic. Methods: The Seniors COVID-19 Pandemic and Exercise (SCOPE) trial was a 3-arm, parallel randomized controlled trial conducted between May and September 2020 in which low active older adults (aged ≥65 years) were recruited via media outlets and social media. After baseline assessments, consented participants were randomized to one of two 12-week exercise programs (delivered online by older adult instructors) or a WLC condition. A total of 241 older adults (n=187 women) provided baseline measures (via online questionnaires), were randomized (ngroup=80, npersonal=82, ncontrol=79), and completed measures every 2 weeks for the duration of the trial. The trial’s primary outcome was psychological flourishing. Secondary outcomes included global measures of mental and physical health, life satisfaction, and depression symptoms. Results: The results of latent growth modeling revealed no intervention effects for flourishing, life satisfaction, or depression symptoms (P>.05 for all). Participants in the group condition displayed improved mental health relative to WLC participants over the first 10 weeks (effect size [ES]=0.288-0.601), and although the week 12 effect (ES=0.375) was in the same direction the difference was not statistically significant (P=.089). Participants in the personal condition displayed improved mental health, when compared with WLC participants, in the same medium ES range (ES=0.293-0.565) over the first 8 weeks, and while the effects were of a similar magnitude at weeks 10 (ES=0.455, P=.069) and 12 (ES=0.258, P=.353), they were not statistically significant. In addition, participants in the group condition displayed improvements in physical health when compared with the WLC (ES=0.079-0.496) across all 12 weeks of the study following baseline. No differences were observed between the personal exercise condition and WLC for physical health (slope P=.271). Conclusions: There were no intervention effects for the trial’s primary outcome (ie, psychological flourishing). It is possible that the high levels of psychological flourishing at baseline may have limited the extent to which those indicators could continue to improve further through intervention (ie, potential ceiling effects). However, the intervention effects for mental and physical health point to the potential capacity of low-cost and scalable at-home programs to support the mental and physical health of previously inactive adults in the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04412343; https://clinicaltrials.gov/ct2/show/NCT04412343 %M 34328433 %R 10.2196/30709 %U https://www.jmir.org/2021/7/e30709 %U https://doi.org/10.2196/30709 %U http://www.ncbi.nlm.nih.gov/pubmed/34328433 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e29315 %T Development, Acceptance, and Concerns Surrounding App-Based Services to Overcome the COVID-19 Outbreak in South Korea: Web-Based Survey Study %A Park,Jihwan %A Han,Jinhyun %A Kim,Yerin %A Rho,Mi Jung %+ Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea, 82 222585905, romy1018@naver.com %K COVID-19 %K app-based services %K acceptance %K concerns %K epidemiological investigation, self-route management app, privacy %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Since the COVID-19 outbreak, South Korea has been engaged in various efforts to overcome the pandemic. One of them is to provide app-based COVID-19–related services to the public. As the pandemic continues, a need for various apps has emerged, including COVID-19 apps that can support activities aimed at overcoming the COVID-19 pandemic. Objective: We aimed to determine which apps were considered the most necessary according to users and evaluate the current status of the development of COVID-19–related apps in South Korea. We also aimed to determine users’ acceptance and concerns related to using apps to support activities to combat COVID-19. Methods: We collected data from 1148 users from a web-based survey conducted between November 11 and December 6, 2020. Basic statistical analysis, multiple response analysis, and the Wilcoxon rank sum test were performed using R software. We then manually classified the current status of the development of COVID-19–related apps. Results: In total, 68.4% (785/1148) of the respondents showed high willingness to protect themselves from COVID-19 by using related apps. Users considered the epidemiological investigation app to be the most necessary app (709/1148, 61.8%) overall, followed by the self-management app for self-isolation (613/1148, 53.4%), self-route management app (605/1148, 52.7%), COVID-19 symptom management app (483/1148, 42.1%), COVID-19–related information provision app (339/1148, 29.5%), and mental health management app (270/1148, 23.5%). Despite the high intention to use these apps, users were also concerned about privacy issues and media exposure. Those who had an underlying disease and had experience using COVID-19–related apps showed significantly higher intentions to use those apps (P=.05 and P=.01, respectively). Conclusions: Targeting users is very important in order to design and develop the most necessary apps. Furthermore, to gain the public’s trust and make the apps available to as many people as possible, it is vital to develop diverse apps in which privacy protection is maximized. %M 34137726 %R 10.2196/29315 %U https://medinform.jmir.org/2021/7/e29315 %U https://doi.org/10.2196/29315 %U http://www.ncbi.nlm.nih.gov/pubmed/34137726 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e25926 %T Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial %A Mhende,Josephine %A Bell,Sharrill A %A Cottrell-Daniels,Cherell %A Luong,Jackie %A Streiff,Micah %A Dannenfelser,Mark %A Hayat,Matthew J %A Spears,Claire Adams %+ Georgia State University, 140 Decatur Street, Suite 400, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu %K acceptability %K addiction %K African American %K cessation %K COVID-19 %K feasibility %K income %K low socioeconomic status %K mHealth %K mindfulness %K minority %K smoking %K SMS %K text messaging %K treatment %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program “iQuit Mindfully” was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers. Objective: This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic. Methods: Participants were adult cigarette smokers (n=23), of whom 8 (34.8%) were female, 19 (82.6%) were African American, and 18 (78.3%) had an annual income of 18 years who worked in Stevenson Center and had access to a mobile phone were eligible to register for a MyCOVIDKey account. All users were encouraged to complete regular self-assessments of COVID-19 risk and to key in to sites by scanning a location-specific barcode. Results: Between June 17, 2020, and July 29, 2020, 45 unique participants created MyCOVIDKey accounts. These users performed 227 self-assessments and 1410 key-ins. Self-assessments were performed by 89% (n=40) of users, 71% (n=32) of users keyed in, and 48 unique locations (of 71 possible locations) were visited. Overall, 89% (202/227) of assessments were determined to be low risk (ie, asymptomatic with no known exposures), and these assessments yielded a CLEAR status. The remaining self-assessments received a status of NOT CLEAR, indicating either risk of exposure or symptoms suggestive of COVID-19 (7.5% [n=17] and 3.5% [n=8] of self-assessments indicated moderate and high risk, respectively). These 25 instances came from 8 unique users, and in 19 of these instances, the at-risk user keyed in to a location on campus. Conclusions: Digital contact tracing tools may be useful in assisting organizations to identify persons at risk of COVID-19 through contact tracing, or in locating places that may need to be cleaned or disinfected after being visited by an index case. Incentives to continue the use of such tools can improve uptake, and their continued usage increases utility to both organizational and public health efforts. Parameters of digital tools, including MyCOVIDKey, should ideally be optimized to supplement existing contact tracing efforts. These tools represent a critical addition to manual contact tracing efforts during reopening and sustained regular activity. %M 33690142 %R 10.2196/24275 %U https://mhealth.jmir.org/2021/3/e24275 %U https://doi.org/10.2196/24275 %U http://www.ncbi.nlm.nih.gov/pubmed/33690142 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e25859 %T App Use and Usability of a Barcode-Based Digital Platform to Augment COVID-19 Contact Tracing: Postpilot Survey and Paradata Analysis %A Scherr,Thomas Foster %A DeSousa,Jenna Maria %A Moore,Carson Paige %A Hardcastle,Austin %A Wright,David Wilson %+ Department of Chemistry, Vanderbilt University, 1234 Stevenson Center Lane, Nashville, TN, 37212, United States, 1 615 322 5516, thomas.f.scherr@vanderbilt.edu %K contact tracing %K COVID-19 %K mobile health %K usability %K app %K usage %K tracking %K monitoring %K survey %K pilot %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has drastically changed life in the United States, as the country has recorded over 23 million cases and 383,000 deaths to date. In the leadup to widespread vaccine deployment, testing and surveillance are critical for detecting and stopping possible routes of transmission. Contact tracing has become an important surveillance measure to control COVID-19 in the United States, and mobile health interventions have found increased prominence in this space. Objective: The aim of this study was to investigate the use and usability of MyCOVIDKey, a mobile-based web app to assist COVID-19 contact tracing efforts, during the 6-week pilot period. Methods: A 6-week study was conducted on the Vanderbilt University campus in Nashville, Tennessee. The study participants, consisting primarily of graduate students, postdoctoral researchers, and faculty in the Chemistry Department at Vanderbilt University, were asked to use the MyCOVIDKey web app during the course of the study period. Paradata were collected as users engaged with the MyCOVIDKey web app. At the end of the study, all participants were asked to report on their user experience in a survey, and the results were analyzed in the context of the user paradata. Results: During the pilot period, 45 users enrolled in MyCOVIDKey. An analysis of their enrollment suggests that initial recruiting efforts were effective; however, participant recruitment and engagement efforts at the midpoint of the study were less effective. App use paralleled the number of users, indicating that incentives were useful for recruiting new users to sign up but did not result in users attempting to artificially inflate their use as a result of prize offers. Times to completion of key tasks were low, indicating that the main features of the app could be used quickly. Of the 45 users, 30 provided feedback through a postpilot survey, with 26 (58%) completing it in its entirety. The MyCOVIDKey app as a whole was rated 70.0 on the System Usability Scale, indicating that it performed above the accepted threshold for usability. When the key-in and self-assessment features were examined on their own, it was found that they individually crossed the same thresholds for acceptable usability but that the key-in feature had a higher margin for improvement. Conclusions: The MyCOVIDKey app was found overall to be a useful tool for COVID-19 contact tracing in a university setting. Most users suggested simple-to-implement improvements, such as replacing the web app framework with a native app format or changing the placement of the scanner within the app workflow. After these updates, this tool could be readily deployed and easily adapted to other settings across the country. The need for digital contact tracing tools is becoming increasingly apparent, particularly as COVID-19 case numbers continue to increase while more businesses begin to reopen. %M 33630745 %R 10.2196/25859 %U https://publichealth.jmir.org/2021/3/e25859 %U https://doi.org/10.2196/25859 %U http://www.ncbi.nlm.nih.gov/pubmed/33630745 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e27882 %T The Dutch COVID-19 Contact Tracing App (the CoronaMelder): Usability Study %A Bente,Britt Elise %A van 't Klooster,Jan Willem Jaap Roderick %A Schreijer,Maud Annemarie %A Berkemeier,Lea %A van Gend,Joris Elmar %A Slijkhuis,Peter Jan Hendrik %A Kelders,Saskia Marion %A van Gemert-Pijnen,Julia Elisabeth Wilhelmina Cornelia %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 53 489 9660, b.e.bente@utwente.nl %K usability testing %K user evaluation %K user experience %K contact tracing apps %K CoronaMelder %K COVID-19 %K pandemic %K mobile apps %K mHealth %K public health %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adoption and evaluation of contact tracing tools based on information and communications technology may expand the reach and efficacy of traditional contact tracing methods in fighting COVID-19. The Dutch Ministry of Health, Welfare and Sports initiated and developed CoronaMelder, a COVID-19 contact tracing app. This app is based on a Google/Apple Exposure Notification approach and aims to combat the spread of the coronavirus among individuals by notifying those who are at increased risk of infection due to proximity to someone who later tests positive for COVID-19. The app should support traditional contact tracing by faster tracing and greater reach compared to regular contact tracing procedures. Objective: The main goal of this study is to investigate whether the CoronaMelder is able to support traditional contact tracing employed by public health authorities. To achieve this, usability tests were conducted to answer the following question: is the CoronaMelder user-friendly, understandable, reliable and credible, and inclusive? Methods: Participants (N=44) of different backgrounds were recruited: youth with varying educational levels, youth with an intellectual disability, migrants, adults (aged 40-64 years), and older adults (aged >65 years) via convenience sampling in the region of Twente in the Netherlands. The app was evaluated with scenario-based, think-aloud usability tests and additional interviews. Findings were recorded via voice recordings, observation notes, and the Dutch User Experience Questionnaire, and some participants wore eye trackers to measure gaze behavior. Results: Our results showed that the app is easy to use, although problems occurred with understandability and accessibility. Older adults and youth with a lower education level did not understand why or under what circumstances they would receive notifications, why they must share their key (ie, their assigned identifier), and what happens after sharing. In particular, youth in the lower-education category did not trust or understand Bluetooth signals, or comprehend timing and follow-up activities after a risk exposure notification. Older adults had difficulties multitasking (speaking with a public health worker and simultaneously sharing the key in the app). Public health authorities appeared to be unprepared to receive support from the app during traditional contact tracing because their telephone conversation protocol lacks guidance, explanation, and empathy. Conclusions: The study indicated that the CoronaMelder app is easy to use, but participants experienced misunderstandings about its functioning. The perceived lack of clarity led to misconceptions about the app, mostly regarding its usefulness and privacy-preserving mechanisms. Tailored and targeted communication through, for example, public campaigns or social media, is necessary to provide correct information about the app to residents in the Netherlands. Additionally, the app should be presented as part of the national coronavirus measures instead of as a stand-alone app offered to the public. Public health workers should be trained to effectively and empathetically instruct users on how to use the CoronaMelder app. %M 33724198 %R 10.2196/27882 %U https://formative.jmir.org/2021/3/e27882 %U https://doi.org/10.2196/27882 %U http://www.ncbi.nlm.nih.gov/pubmed/33724198 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25696 %T Modeling Predictive Age-Dependent and Age-Independent Symptoms and Comorbidities of Patients Seeking Treatment for COVID-19: Model Development and Validation Study %A Huang,Yingxiang %A Radenkovic,Dina %A Perez,Kevin %A Nadeau,Kari %A Verdin,Eric %A Furman,David %+ Buck Institute for Research on Aging, 8001 Redwood Blvd, Novato, CA, 94945, United States, 1 (415) 209 2000, DFurman@buckinstitute.org %K clinical informatics %K predictive modeling %K COVID-19 %K app %K model %K prediction %K symptom %K informatics %K age %K morbidity %K hospital %D 2021 %7 25.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic continues to ravage and burden hospitals around the world. The epidemic started in Wuhan, China, and was subsequently recognized by the World Health Organization as an international public health emergency and declared a pandemic in March 2020. Since then, the disruptions caused by the COVID-19 pandemic have had an unparalleled effect on all aspects of life. Objective: With increasing total hospitalization and intensive care unit admissions, a better understanding of features related to patients with COVID-19 could help health care workers stratify patients based on the risk of developing a more severe case of COVID-19. Using predictive models, we strive to select the features that are most associated with more severe cases of COVID-19. Methods: Over 3 million participants reported their potential symptoms of COVID-19, along with their comorbidities and demographic information, on a smartphone-based app. Using data from the >10,000 individuals who indicated that they had tested positive for COVID-19 in the United Kingdom, we leveraged the Elastic Net regularized binary classifier to derive the predictors that are most correlated with users having a severe enough case of COVID-19 to seek treatment in a hospital setting. We then analyzed such features in relation to age and other demographics and their longitudinal trend. Results: The most predictive features found include fever, use of immunosuppressant medication, use of a mobility aid, shortness of breath, and severe fatigue. Such features are age-related, and some are disproportionally high in minority populations. Conclusions: Predictors selected from the predictive models can be used to stratify patients into groups based on how much medical attention they are expected to require. This could help health care workers devote valuable resources to prevent the escalation of the disease in vulnerable populations. %M 33621185 %R 10.2196/25696 %U https://www.jmir.org/2021/3/e25696 %U https://doi.org/10.2196/25696 %U http://www.ncbi.nlm.nih.gov/pubmed/33621185 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26182 %T A Self-Assessment Web-Based App to Assess Trends of the COVID-19 Pandemic in France: Observational Study %A Denis,Fabrice %A Fontanet,Arnaud %A Le Douarin,Yann-Mael %A Le Goff,Florian %A Jeanneau,Stephan %A Lescure,François-Xavier %+ Institut Inter-régional de Cancérologie Jean Bernard, 9 rue Beauverger, Le Mans, 72000, France, 33 684190480, f.denis@cjb72.org %K app %K big data %K COVID-19 %K diagnosis %K diagnostic test %K digital health %K France %K mobile phone %K observational %K participatory app %K self-assessment %K surveillance %K trend %K web-based app %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: We developed a self-assessment and participatory web-based triage app to assess the trends of the COVID-19 pandemic in France in March 2020. Objective: We compared daily large-scale RT–PCR test results to monitor recent reports of anosmia through a web-based app to assess the dynamics of emergency department visits, hospitalizations, and intensive care unit (ICU) admissions among individuals with COVID-19 in France. Methods: Between March 21 and November 18, 2020, users of the maladiecoronavirus.fr self-triage app were asked questions about COVID-19 symptoms. Data on daily hospitalizations, large-scale positive results on RT–PCR tests, emergency department visits, and ICU admission of individuals with COVID-19 were compared to data on daily reports of anosmia on the app. Results: As of November 18, 2020, recent anosmia was reported 575,214 times from among approximately 13,000,000 responses. Daily anosmia reports during peak engagement with the app on September 16, 2020, were spatially correlated with the peak in daily COVID-19–related hospitalizations in November 2020 (Spearman rank correlation coefficient [ρ]=0.77; P<.001). This peak in daily anosmia reports was observed primarily among young adults (age range 18-40 years), being observed 49 days before the peak of hospitalizations that corresponded to the first wave of infections among the young population, followed by a peak in hospitalizations among older individuals (aged ≥50 years) in November 2020. The reduction in the daily reports of anosmia associated with the peaks in the number of cases preceded the reduction in daily hospitalizations by 10 and 9 days during the first and the second waves of infection, respectively, although the reduction in the positivity rates on RT–PCR tests preceded the reduction in daily hospitalizations by only 2 days during the second wave of infections. Conclusions: Data on daily reports of anosmia collected through a nationwide, web-based self-assessment app can be a relevant tool to anticipate surges in outbreaks, hospitalizations, and ICU admission during the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04331171; https://clinicaltrials.gov/ct2/show/NCT04331171 %M 33709945 %R 10.2196/26182 %U https://www.jmir.org/2021/3/e26182 %U https://doi.org/10.2196/26182 %U http://www.ncbi.nlm.nih.gov/pubmed/33709945 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e26168 %T Rapid Design and Delivery of an Experience-Based Co-designed Mobile App to Support the Mental Health Needs of Health Care Workers Affected by the COVID-19 Pandemic: Impact Evaluation Protocol %A Lewis,Matthew %A Palmer,Victoria J %A Kotevski,Aneta %A Densley,Konstancja %A O'Donnell,Meaghan L %A Johnson,Caroline %A Wohlgezogen,Franz %A Gray,Kathleen %A Robins-Browne,Kate %A Burchill,Luke %+ Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 4th Floor, Clinical Sciences Building, Parkville, 3050, Australia, 61 3 8344 7161, blj@unimelb.edu.au %K mental health %K mobile applications %K COVID-19 %K health personnel %K experience-based co-design %K impact %K evaluation %K digital interventions %K app %K intervention %K health care worker %K design %K delivery %K support %D 2021 %7 9.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has highlighted the importance of health care workers’ mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers. Objective: RMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app. Methods: The impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days. Results: The anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021. Conclusions: The impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely. International Registered Report Identifier (IRRID): DERR1-10.2196/26168 %M 33635823 %R 10.2196/26168 %U https://www.researchprotocols.org/2021/3/e26168 %U https://doi.org/10.2196/26168 %U http://www.ncbi.nlm.nih.gov/pubmed/33635823 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e23843 %T A Patient-Initiated Digital COVID-19 Contact Notification Tool (TellYourContacts): Evaluation Study %A Okpara,Kelechi S %A Hecht,Jennifer %A Wohlfeiler,Dan %A Prior,Matthew %A Klausner,Jeffrey D %+ David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, United States, 1 (310) 825 6373, kokpara@mednet.ucla.edu %K patient-led digital contact notification %K COVID-19 %K digital contact tracing %K contact notification website %D 2021 %7 5.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Contact notification is a method used to control the spread of infectious disease. In this process, a patient who tests positive for an infectious disease and public health officials work to identify the patient’s close contacts, notify them of their risk of possible exposure to the disease, and provide resources to facilitate the decreased spreading of disease. Contact notification can be done physically in person, via phone call, or digitally through the use of media such as SMS text messages and email. When alerts are made through the latter, it is called digital contact notification. Objective: For this study, we aim to perform a preliminary evaluation of the use of the TellYourContacts website, a digital contact notification tool for COVID-19 that can be used confidentially and anonymously. We will gather information about the number of website users and message senders, the types of messages sent, and the geographic distribution of senders. Methods: Patients who chose to get tested for COVID-19 and subsequently tested positive for the disease were alerted of their positive results through Curative Inc (a COVID-19 testing laboratory) and Healthvana (a results disclosure app). Included in the notification was a link to the TellYourContacts website and a message encouraging the person who tested positive for COVID-19 to use the website to alert their close contacts of exposure risk. Over the course of three months, from May 18, 2020, to August 17, 2020, we used Google Analytics and Microsoft Excel to record data on the number of website users and message senders, types of messages sent, and geographic distribution of the senders. Results: Over the course of three months, 9130 users accessed the website and 1474 unique senders sent a total of 1957 messages, which included 1820 (93%) SMS text messages and 137 (7%) emails. Users sent messages from 40 US states, with the majority of US senders residing in California (49%). Conclusions: We set out to determine if individuals who test positive for COVID-19 will use the TellYourContacts website to notify their close contacts of COVID-19 exposure risk. Our findings reveal that, during the observation period, each unique sender sent an average of 1.33 messages. The TellYourContacts website offers an additional method that individuals can and will use to notify their close contacts about a recent COVID-19 diagnosis. %M 33621189 %R 10.2196/23843 %U https://formative.jmir.org/2021/3/e23843 %U https://doi.org/10.2196/23843 %U http://www.ncbi.nlm.nih.gov/pubmed/33621189 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25726 %T Adoption of COVID-19 Contact Tracing Apps: A Balance Between Privacy and Effectiveness %A Seto,Emily %A Challa,Priyanka %A Ware,Patrick %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada, 1 416 669 9295, emily.seto@utoronto.ca %K mobile apps %K COVID-19 %K contact tracing %K exposure notification %K privacy %K effectiveness %K app %K surveillance %K tracing %K transmission %K security %K digital health %D 2021 %7 4.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X With the relative ubiquity of smartphones, contact tracing and exposure notification apps have been looked to as novel methods to help reduce the transmission of COVID-19. Many countries have created apps that lie across a spectrum from privacy-first approaches to those that have very few privacy measures. The level of privacy incorporated into an app is largely based on the societal norms and values of a particular country. Digital health technologies can be highly effective and preserve privacy at the same time, but in the case of contact tracing and exposure notification apps, there is a trade-off between increased privacy measures and the effectiveness of the app. In this article, examples from various countries are used to highlight how characteristics of contract tracing and exposure notification apps contribute to the perceived levels of privacy awarded to citizens and how this impacts an app’s effectiveness. We conclude that finding the right balance between privacy and effectiveness, while critical, is challenging because it is highly context-specific. %M 33617459 %R 10.2196/25726 %U https://www.jmir.org/2021/3/e25726 %U https://doi.org/10.2196/25726 %U http://www.ncbi.nlm.nih.gov/pubmed/33617459 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26399 %T Health Care Students’ Knowledge of and Attitudes, Beliefs, and Practices Toward the French COVID-19 App: Cross-sectional Questionnaire Study %A Montagni,Ilaria %A Roussel,Nicolas %A Thiébaut,Rodolphe %A Tzourio,Christophe %+ Bordeaux Population Health Research Center, U1219, Bordeaux University, INSERM, 146 rue Léo Saignat, Bordeaux, 33000, France, 33 05 57 57 16 5, ilaria.montagni@u-bordeaux.fr %K contact tracing %K COVID-19 %K mobile app %K students %K field survey %K app %K survey %K monitoring %K knowledge %K attitude %K belief %K practice %K communication %K use %D 2021 %7 3.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many countries worldwide have developed mobile phone apps capable of supporting instantaneous contact tracing to control the COVID-19 pandemic. In France, a few people have downloaded and are using the StopCovid contact tracing app. Students in the health domain are of particular concern in terms of app uptake. Exploring their use and opinions about the app can inform improvements and diffusion of StopCovid among young people. Objective: The aim of this study is to investigate health care students’ knowledge of and attitudes, beliefs, and practices (KABP) toward the StopCovid app. Methods: A field survey was conducted among 318 students at the health sciences campus of the University of Bordeaux, France, between September 25 and October 16, 2020. A quota sampling method was used, and descriptive statistics and univariate analyses were performed. Results: Of the 318 respondents, 77.3% (n=246) had heard about the app, but only 11.3% (n=36) had downloaded it, and 4.7% (n=15) were still using it at the time of the survey. Among the 210 participants who had heard about the app but did not download it, the main reasons for not using the app were a belief that it was not effective given its limited diffusion (n=37, 17.6%), a lack of interest (n=37, 17.6%), and distrust in the data security and fear of being geolocated (n=33, 15.7%). Among the 72 students who had not heard of the app and were given a brief description of its functioning and confidentiality policy, 52.7% (n=38) said they would use it. Participants reported that the main solution for increasing the use of the app would be better communication about it (227/318, 71.4%). Conclusions: Even among health students, the contact tracing app was poorly used. The findings suggest that improved communication about its advantages and simplicity of use as well as clarifying false beliefs about it could help improve uptake. %M 33566793 %R 10.2196/26399 %U https://www.jmir.org/2021/3/e26399 %U https://doi.org/10.2196/26399 %U http://www.ncbi.nlm.nih.gov/pubmed/33566793 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e24322 %T Health Apps for Combating COVID-19: Descriptive Review and Taxonomy %A Almalki,Manal %A Giannicchi,Anna %+ Department of Health Informatics, Faculty of Public Health and Tropical Medicine, Jazan University, Gizan, Jazan, 82726, Saudi Arabia, 966 597636563, manal_almalki@hotmail.com %K app %K COVID-19 %K corona %K self-care %K personal tracking %K review %K mHealth %K track %K surveillance %K awareness %K exposure %K consumer health informatics %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps have been leveraged to combat the spread of COVID-19. However, little is known about these technologies’ characteristics, technical features, and various applications in health care when responding to this public health crisis. The lack of understanding has led developers and governments to make poor choices about apps’ designs, which resulted in creating less useful apps that are overall less appealing to consumers due to their technical flaws. Objective: This review aims to identify, analyze, and categorize health apps related to COVID-19 that are currently available for consumers in app stores; in particular, it focuses on exploring their key technical features and classifying the purposes that these apps were designed to serve. Methods: A review of health apps was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The Apple Store and Google Play were searched between April 20 and September 11, 2020. An app was included if it was dedicated for this disease and was listed under the health and medical categories in these app stores. The descriptions of these apps were extracted from the apps’ web pages and thematically analyzed via open coding to identify both their key technical features and overall purpose. The characteristics of the included apps were summarized and presented with descriptive statistics. Results: Of the 298 health apps that were initially retrieved, 115 met the inclusion criteria. A total of 29 technical features were found in our sample of apps, which were then categorized into five key purposes of apps related to COVID-19. A total of 77 (67%) apps were developed by governments or national authorities and for the purpose of promoting users to track their personal health (9/29, 31%). Other purposes included raising awareness on how to combat COVID-19 (8/29, 27%), managing exposure to COVID-19 (6/29, 20%), monitoring health by health care professionals (5/29, 17%), and conducting research studies (1/29, 3.5%). Conclusions: This study provides an overview and taxonomy of the health apps currently available in the market to combat COVID-19 based on their differences in basic technical features and purpose. As most of the apps were provided by governments or national authorities, it indicates the essential role these apps have as tools in public health crisis management. By involving most of the population in self-tracking their personal health and providing them with the technology to self-assess, the role of these apps is deemed to be a key driver for a participatory approach to curtail the spread of COVID-19. Further effort is required from researchers to evaluate these apps’ effectiveness and from governmental organizations to increase public awareness of these digital solutions. %M 33626017 %R 10.2196/24322 %U https://mhealth.jmir.org/2021/3/e24322 %U https://doi.org/10.2196/24322 %U http://www.ncbi.nlm.nih.gov/pubmed/33626017 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26559 %T Exploring Usage of COVID Coach, a Public Mental Health App Designed for the COVID-19 Pandemic: Evaluation of Analytics Data %A Jaworski,Beth K %A Taylor,Katherine %A Ramsey,Kelly M %A Heinz,Adrienne %A Steinmetz,Sarah %A Pagano,Ian %A Moraja,Giovanni %A Owen,Jason E %+ National Center for PTSD, Dissemination & Training Division, US Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, United States, 1 650 308 9437, beth.jaworski@va.gov %K COVID-19 %K coronavirus %K mobile app %K mHealth %K digital health %K mental health %K public mental health %K stress %K coping %K public health %K app %D 2021 %7 1.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has significantly impacted mental health and well-being. Mobile mental health apps can be scalable and useful tools in large-scale disaster responses and are particularly promising for reaching vulnerable populations. COVID Coach is a free, evidence-informed mobile app designed specifically to provide tools and resources for addressing COVID-19–related stress. Objective: The purpose of this study was to characterize the overall usage of COVID Coach, explore retention and return usage, and assess whether the app was reaching individuals who may benefit from mental health resources. Methods: Anonymous usage data collected from COVID Coach between May 1, 2020, through October 31, 2020, were extracted and analyzed for this study. The sample included 49,287 unique user codes and 3,368,931 in-app events. Results: Usage of interactive tools for coping and stress management comprised the majority of key app events (n=325,691, 70.4%), and the majority of app users tried a tool for managing stress (n=28,009, 58.8%). COVID Coach was utilized for ≤3 days by 80.9% (n=34,611) of the sample whose first day of app use occurred within the 6-month observation window. Usage of the key content in COVID Coach predicted returning to the app for a second day. Among those who tried at least one coping tool on their first day of app use, 57.2% (n=11,444) returned for a second visit; whereas only 46.3% (n=10,546) of those who did not try a tool returned (P<.001). Symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) were prevalent among app users. For example, among app users who completed an anxiety assessment on their first day of app use (n=4870, 11.4% of users), 55.1% (n=2680) reported levels of anxiety that were moderate to severe, and 29.9% (n=1455) of scores fell into the severe symptom range. On average, those with moderate levels of depression on their first day of app use returned to the app for a greater number of days (mean 3.72 days) than those with minimal symptoms (mean 3.08 days; t1=3.01, P=.003). Individuals with significant PTSD symptoms on their first day of app use utilized the app for a significantly greater number of days (mean 3.79 days) than those with fewer symptoms (mean 3.13 days; t1=2.29, P=.02). Conclusions: As the mental health impacts of the pandemic continue to be widespread and increasing, digital health resources, such as apps like COVID Coach, are a scalable way to provide evidence-informed tools and resources. Future research is needed to better understand for whom and under what conditions the app is most helpful and how to increase and sustain engagement. %M 33606656 %R 10.2196/26559 %U https://www.jmir.org/2021/3/e26559 %U https://doi.org/10.2196/26559 %U http://www.ncbi.nlm.nih.gov/pubmed/33606656 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e25345 %T Challenges for Nontechnical Implementation of Digital Proximity Tracing During the COVID-19 Pandemic: Media Analysis of the SwissCovid App %A von Wyl,Viktor %+ Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, Zürich, 8001, Switzerland, 41 +41446346380, viktor.vonwyl@uzh.ch %K epidemiology %K normalization process theory %K implementation %K digital health %K digital proximity tracing %K digital contact tracing %K COVID-19 %K app %K surveillance %K implementation %K tracking %K tracing %K framework %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Several countries have released digital proximity tracing (DPT) apps to complement manual contact tracing for combatting the SARS-CoV-2 pandemic. DPT aims 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 the embedding of DPT into the pandemic mitigation strategy. Objective: By searching for media articles published during the first 3 months after DPT launch, the implementation of DPT in Switzerland was evaluated to inform similar undertakings in other countries. The second aim of the study was to create a link between reported DPT implementation challenges and normalization process theory for planning and optimizing complex digital health interventions, which can provide useful guidance for decision-making in 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 July 4 and October 3, 2020. In a structured process, topics were extracted and clustered manually from articles that were deemed pertinent. Extracted topics were mapped to four NPT constructs, which reflected the flow of intervention development from planning, stakeholder onboarding, and execution to critical appraisal. Coherence constructs describe sense-making by stakeholders, cognitive participation constructs reflect participants’ efforts to create engagement with the intervention, collective actions refer to intervention execution and joint stakeholder efforts to make the intervention work, and reflexive monitoring refers to collective risk-benefit appraisals to create improvements. Results: Out of 94 articles deemed pertinent and selected for closer inspection, 38 provided unique information on implementation challenges. Five challenge areas were identified: communication challenges, challenges for DPT to interface with other processes, fear of resource competition with established pandemic mitigation measures, unclear DPT effectiveness, and obstacles to greater user coverage and compliance. Specifically, several articles mentioned unclear DPT benefits to affect commitment and to raise fears among different health system actors regarding resource competition. 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 health system actors. Finally, 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. NPT provided a well-fitting framework to contextualize the different DPT implementation challenges and to highlight improvement strategies, namely a better alignment of stakeholder incentives, or stakeholder-specific communication to address their concerns about DPT. Conclusions: Early experiences from one of the first adopters of DPT indicate that nontechnical implementation challenges may affect the effectiveness of DPT. The NPT analysis provides a novel perspective on DPT implementation and stresses the need for stakeholder inclusion in development and operationalization. %M 33606658 %R 10.2196/25345 %U https://mhealth.jmir.org/2021/2/e25345 %U https://doi.org/10.2196/25345 %U http://www.ncbi.nlm.nih.gov/pubmed/33606658 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24452 %T A Mobile App to Facilitate Socially Distanced Hospital Communication During COVID-19: Implementation Experience %A Anyanwu,Emeka C %A Ward,R Parker %A Shah,Atman %A Arora,Vineet %A Umscheid,Craig A %+ Section of Cardiology, University of Chicago, 5841 S Maryland Avenue, Chicago, IL, 60637, United States, 1 (773) 834 0343, emeka@emeka.ca %K adoption %K communication %K COVID-19 %K hospital %K inpatient %K mHealth %K mobile app %K telemedicine %D 2021 %7 23.2.2021 %9 Short Paper %J JMIR Mhealth Uhealth %G English %X Background: COVID-19 has significantly altered health care delivery, requiring clinicians and hospitals to adapt to rapidly changing hospital policies and social distancing guidelines. At our large academic medical center, clinicians reported that existing information on distribution channels, including emails and hospital intranet posts, was inadequate to keep everyone abreast with these changes. To address these challenges, we adapted a mobile app developed in-house to communicate critical changes in hospital policies and enable direct telephonic communication between clinical team members and hospitalized patients, to support social distancing guidelines and remote rounding. Objective: This study aimed to describe the unique benefits and challenges of adapting an app developed in-house to facilitate communication and remote rounding during COVID-19. Methods: We adapted moblMD, a mobile app available on the iOS and Android platforms. In conjunction with our Hospital Incident Command System, resident advisory council, and health system innovation center, we identified critical, time-sensitive policies for app usage. A shared collaborative document was used to align app-based communication with more traditional communication channels. To minimize synchronization efforts, we particularly focused on high-yield policies, and the time of last review and the corresponding reviewer were noted for each protocol. To facilitate social distancing and remote patient rounding, the app was also populated with a searchable directory of numbers to patient bedside phones and hospital locations. We monitored anonymized user activity from February 1 to July 31, 2020. Results: On its first release, 1104 clinicians downloaded moblMD during the observation period, of which 46% (n=508) of downloads occurred within 72 hours of initial release. COVID-19 policies in the app were reviewed most commonly during the first week (801 views). Users made sustained use of hospital phone dialing features, including weekly peaks of 2242 phone number dials, 1874 directory searches, and 277 patient room phone number searches through the last 2 weeks of the observation period. Furthermore, clinicians submitted 56 content- and phone number–related suggestions through moblMD. Conclusions: We rapidly developed and deployed a communication-focused mobile app early during COVID-19, which has demonstrated initial and sustained value among clinicians in communicating with in-patients and each other during social distancing. Our internal innovation benefited from our team’s familiarity with institutional structures, short feedback loops, limited security and privacy implications, and a path toward sustainability provided by our innovation center. Challenges in content management were overcome through synchronization efforts and timestamping review. As COVID-19 continues to alter health care delivery, user activity metrics suggest that our solution will remain important in our efforts to continue providing safe and up-to-date clinical care. %M 33513562 %R 10.2196/24452 %U https://mhealth.jmir.org/2021/2/e24452 %U https://doi.org/10.2196/24452 %U http://www.ncbi.nlm.nih.gov/pubmed/33513562 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e23155 %T Willingness to Adopt mHealth Among Chinese Parents During the COVID-19 Outbreak: Cross-sectional Questionnaire Study %A Yang,Siyu %A Chen,Yijing %A Zhou,Leshan %A Huang,Yuting %A Dai,Jiahui %+ Xiangya Nursing School, Central South University, No172 Tongzipo Road, Yuelu District, Changsha, China, 86 1897516606, leshanzhou@csu.edu.cn %K mHealth %K parents %K child health at home %K COVID-19 %D 2021 %7 27.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parental involvement in mobile health (mHealth) to consult with medical professionals appears to be prevalent in China with the rapid development of the internet. More parents with busy jobs have chosen to use mHealth. During the ongoing COVID-19 outbreak, mHealth can assist with health promotion, directions for medication use, and disease diagnosis via online chat and video consultation without contacting others. To our knowledge, no studies have been performed to explore the role of mHealth in parents’ attitudes toward child health care at home during the COVID-19 outbreak. Objective: This study aims to identify the associated factors of willingness to adopt mHealth among Chinese parents during the COVID-19 outbreak and to explore the correlation between the frequency of adopting mHealth and parents’ attitudes toward child health care at home. Methods: Chinese parents were asked to complete an online survey from January 25 to February 15, 2020. The questionnaire comprised of two parts with a total of 16 items, including parents’ demographic variables and attitudes toward child health care at home. By multivariate logistic regression, we explored factors associated with parents’ willingness to adopt mHealth during the COVID-19 outbreak. Pearson chi-square tests were used to reveal the correlation between the frequency of adopting mHealth and parents’ attitudes toward child health care at home. Results: A total of 254 parents enrolled, and 202 (79.5%) parents were willing to adopt mHealth during the COVID-19 outbreak. Parents’ age (26-35 years: adjusted odds ratio [AOR] 8.114, 95% CI 1.471-44.764), parents’ interest in the COVID-19 pandemic (moderate: AOR 8.753, 95% CI 2.009-38.127; high: AOR 22.194, 95% CI 5.509-89.411), the source that recommended mHealth (medical health providers: AOR 4.257, 95% CI 1.439-12.596), the presence of chronic disease in their children (yes: AOR 20.844, 95% CI 4.600-94.443), parents’ duration of daily internet use (4-6 hours: AOR 6.487, 95% CI 1.870-22.495; >6 hours: AOR 8.766, 95% CI 1.883-40.804), and adoption of mHealth before the COVID-19 outbreak (yes: AOR 3.413, 95% CI 1.234-9.444) were significantly correlated with the parents’ willingness to adopt mHealth during the COVID-19 outbreak. The frequency of mHealth use among parents was correlated with their behaviors in regard to handwashing (χ26=18.967, P=.004), mask wearing (χ26=45.364, P<.001), frequency of leaving the home (χ26=16.767, P=.01), room disinfection and ventilation (χ26=19.515, P=.003), temperature checking (χ26=17.47, P=.007), and mental health care of children (χ26=63.810, P<.001) during the COVID-19 pandemic. Conclusions: We found various objective factors that were associated with parents’ willingness to adopt mHealth during the COVID-19 outbreak. Overall, parents’ willingness to adopt mHealth was high. The frequency of mHealth use among parents was correlated with their attitudes toward child health care at home. The option of mHealth to patients at home during the COVID-19 outbreak would be beneficial for education and improvement in self-management of child health care at home. %M 33406052 %R 10.2196/23155 %U http://mhealth.jmir.org/2021/1/e23155/ %U https://doi.org/10.2196/23155 %U http://www.ncbi.nlm.nih.gov/pubmed/33406052 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e23190 %T Mobile App–Based Remote Patient Monitoring in Acute Medical Conditions: Prospective Feasibility Study Exploring Digital Health Solutions on Clinical Workload During the COVID Crisis %A Shah,Sachin Shailendra %A Gvozdanovic,Andrew %A Knight,Matthew %A Gagnon,Julien %+ Huma Therapeutics, 13th Floor Millbank Tower, 21-24 Millbank, London, SW1P 4QP, United Kingdom, 44 7875210783, sachsshah@gmail.com %K mHealth %K remote patient monitoring %K digital health %K COVID-19 %K service improvement %K cost-effectiveness %K monitoring %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital remote patient monitoring can add value to virtual wards; this has become more apparent in the context of the COVID-19 pandemic. Health care providers are overwhelmed, resulting in clinical teams spread more thinly. We aimed to assess the impact of introducing an app-based remote patient monitoring system (Huma Therapeutics) on a clinician’s workload in the context of a COVID-19–specific virtual ward. Objective: This prospective feasibility study aimed to evaluate the health economic effects (in terms of clinical workload) of a mobile app on a telephone-based virtual ward used in the monitoring of patients with COVID-19 who are clinically ready for discharge from the hospital. Methods: A prospective feasibility study was carried out over 1 month where clinician workload was monitored, and full-time equivalents savings were determined. An NHS hospital repurposed a telephone-based respiratory virtual ward for COVID-19. Patients with COVID-19 in the amber zone (according to the National Health Service definition) were monitored for 14 days postdischarge to help identify deteriorating patients earlier. A smartphone-based app was introduced to monitor data points submitted by the patients via communication over telephone calls. We then comparatively evaluated the clinical workload between patients monitored by telephone only (cohort 1) with those monitored via mobile app and telephone (cohort 2). Results: In all, 56 patients were enrolled in the app-based virtual ward (cohort 2). Digital remote patient monitoring resulted in a reduction in the number of phone calls from a mean total of 9 calls to 4 calls over the monitoring period. There was no change in the mean duration of phone calls (8.5 minutes) and no reports of readmission or mortality. These results equate to a mean saving of 47.60 working hours. Moreover, it translates to 3.30 fewer full-time equivalents (raw phone call data), resulting in 1.1 fewer full-time equivalents required to monitor 100 patients when adjusted for time spent reviewing app data. Individual clinicians spent an average of 10.9 minutes per day reviewing data. Conclusions: Smartphone-based remote patient monitoring technologies may offer tangible reductions in clinician workload at a time when service is severely strained. In this small-scale pilot study, we demonstrated the economic and operational impact that digital remote patient monitoring technology can have in improving working efficiency and reducing operational costs. Although this particular RPM solution was deployed for the COVID-19 pandemic, it may set a precedent for wider utilization of digital, remote patient monitoring solutions in other clinical scenarios where increased care delivery efficiency is sought. %M 33400675 %R 10.2196/23190 %U http://formative.jmir.org/2021/1/e23190/ %U https://doi.org/10.2196/23190 %U http://www.ncbi.nlm.nih.gov/pubmed/33400675 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e24693 %T Attitudes Toward Using COVID-19 mHealth Tools Among Adults With Chronic Health Conditions: Secondary Data Analysis of the COVID-19 Impact Survey %A Camacho-Rivera,Marlene %A Islam,Jessica Yasmine %A Rivera,Argelis %A Vidot,Denise Christina %+ Department of Community Health Sciences, State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, MSC 43, Brooklyn, NY, 11203, United States, 1 7182704386, marlene.camacho-rivera@downstate.edu %K smartphone %K mHealth %K COVID-19 %K chronic health conditions %K health disparities %K chronic disease %K attitude %K perception %K data analysis %K contact tracing %K mobile app %K disparity %D 2020 %7 17.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adults with chronic conditions are disproportionately burdened by COVID-19 morbidity and mortality. Although COVID-19 mobile health (mHealth) apps have emerged, research on attitudes toward using COVID-19 mHealth tools among those with chronic conditions is scarce. Objective: This study aimed to examine attitudes toward COVID-19, identify determinants of COVID-19 mHealth tool use across demographic and health-related characteristics, and evaluate associations between chronic health conditions and attitudes toward using COVID-19 mHealth tools (eg, mHealth or web-based methods for tracking COVID-19 exposures, symptoms, and recommendations). Methods: We used nationally representative data from the COVID-19 Impact Survey collected from April to June 2020 (n=10,760). Primary exposure was a history of chronic conditions, which were defined as self-reported diagnoses of cardiometabolic, respiratory, immune-related, and mental health conditions and overweight/obesity. Primary outcomes were attitudes toward COVID-19 mHealth tools, including the likelihood of using (1) a mobile phone app to track COVID-19 symptoms and receive recommendations; (2) a website to track COVID-19 symptoms, track location, and receive recommendations; and (3) an app using location data to track potential COVID-19 exposure. Outcome response options for COVID-19 mHealth tool use were extremely/very likely, moderately likely, or not too likely/not likely at all. Multinomial logistic regression was used to compare the likelihood of COVID-19 mHealth tool use between people with different chronic health conditions, with not too likely/not likely at all responses used as the reference category for each outcome. We evaluated the determinants of each COVID-19 mHealth intervention using Poisson regression. Results: Of the 10,760 respondents, 21.8% of respondents were extremely/very likely to use a mobile phone app or a website to track their COVID-19 symptoms and receive recommendations. Additionally, 24.1% of respondents were extremely/very likely to use a mobile phone app to track their location and receive push notifications about whether they have been exposed to COVID-19. After adjusting for age, race/ethnicity, sex, socioeconomic status, and residence, adults with mental health conditions were the most likely to report being extremely/very or moderately likely to use each mHealth intervention compared to those without such conditions. Adults with respiratory-related chronic diseases were extremely/very (conditional odds ratio 1.16, 95% CI 1.00-1.35) and moderately likely (conditional odds ratio 1.23, 95% CI 1.04-1.45) to use a mobile phone app to track their location and receive push notifications about whether they have been exposed to COVID-19. Conclusions: Our study demonstrates that attitudes toward using COVID-19 mHealth tools vary widely across modalities (eg, web-based method vs app) and chronic health conditions. These findings may inform the adoption of long-term engagement with COVID-19 apps, which is crucial for determining their potential in reducing disparities in COVID-19 morbidity and mortality among individuals with chronic health conditions. %M 33301415 %R 10.2196/24693 %U http://mhealth.jmir.org/2020/12/e24693/ %U https://doi.org/10.2196/24693 %U http://www.ncbi.nlm.nih.gov/pubmed/33301415 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e22874 %T Use of WhatsApp for Polyclinic Consultation of Suspected Patients With COVID-19: Retrospective Case Control Study %A Sabırlı,Ramazan %A Karsli,Emre %A Canacik,Omer %A Ercin,Dogan %A Çiftçi,Handan %A Sahin,Levent %A Dolanbay,Turgut %A Tutuncu,Emin Ediz %+ Kafkas University Faculty of Medicine, Department of Emergency Medicine, Kafkas University Hospital, Kars, 36000, Turkey, 90 5387344298, ramazan_sabirli@hotmail.com %K telemedicine %K WhatsApp %K ED crowding %K COVID-19 %K emergency department %K messaging %K communication %K consultation %K clinic %K infectious disease %D 2020 %7 11.12.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Telephones, internet-connected devices (phablets, personal computers), chat platforms, and mobile apps (eg, Skype, Facebook Messenger, WhatsApp) can be exploited for telemedicine applications. WhatsApp and similar apps are also widely used to facilitate clinical communication between physicians. Moreover, WhatsApp is used by emergency department (ED) physicians and consulting physicians to exchange medical information during ED consultations. This platform is regarded as a useful app in the consultation of dermatological and orthopedic cases. Preventing overcrowding in the ED is key to reducing the risk of disease transmission, and teleconsulting practice is thought to be effective in the diagnosis, treatment, and reduction of transmission risk of disease, most notably during the COVID-19 pandemic. Video consultation is highly recommended in some countries on the grounds that it is likely to reduce the risk of transmission. WhatsApp-like apps are among the video consultation platforms that are assumed to reduce the risk of contamination by minimizing patient-physician contact. Objective: The aim of this study was to investigate the effects of WhatsApp video consultation on patient admission and discharge times in comparison to bedside consultation in the evaluation of potential patients with COVID-19 visiting a COVID-19 outpatient clinic during the pandemic. Methods: Patients who presented to the ED COVID-19 outpatient clinic between March 11 and May 31, 2020, and for whom an infectious disease specialist was consulted (via WhatsApp or at bedside) were included in the study in accordance with the inclusion and exclusion criteria. Eventually, 54 patients whose consultations were performed via WhatsApp and 90 patients whose consultations were performed at bedside were included in our study. Results: The median length of stay in the ED of discharged patients amounted to 103 minutes (IQR 85-147.75) in the WhatsApp group and 196 minutes (IQR 141-215) in the bedside group. In this regard, the length of stay in the ED was found to be significantly shorter in the WhatsApp group than in the bedside group (P<.001). Among the consulted and discharged patients, 1 patient in each group tested positive for SARS-CoV-2 by polymerase chain reaction test and thus was readmitted and hospitalized (P=.62). The median length of stay of the inpatients in the ED was found to be 116.5 minutes (IQR 85.5-145.5) in the WhatsApp group and 132 minutes (IQR 102-168) in the bedside group. The statistical analysis of this time difference revealed that the length of stay in the ED was significantly shorter for patients in the WhatsApp group than in the bedside group (P=.04). Conclusions: Consultation via WhatsApp reduces both contact time with patients with COVID-19 and the number of medical staff contacting the patients, which contributes greatly to reducing the risk of COVID-19 transmission. WhatsApp consultation may prove useful in clinical decision making as well as in shortening process times. Moreover, it does not result in a decreased accuracy rate. The shortened discharge and hospitalization timespans also decreased the length of stay in the ED, which can have an impact on minimizing ED crowding. Trial Registration: ClinicalTrials.gov NCT04645563; https://clinicaltrials.gov/ct2/show/NCT04645563. %M 33276318 %R 10.2196/22874 %U http://mhealth.jmir.org/2020/12/e22874/ %U https://doi.org/10.2196/22874 %U http://www.ncbi.nlm.nih.gov/pubmed/33276318 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23170 %T COVID-19 Mobile Apps: A Systematic Review of the Literature %A Kondylakis,Haridimos %A Katehakis,Dimitrios G %A Kouroubali,Angelina %A Logothetidis,Fokion %A Triantafyllidis,Andreas %A Kalamaras,Ilias %A Votis,Konstantinos %A Tzovaras,Dimitrios %+ Computational Biomedicine Laboratory, Foundation for Research and Technology - Hellas–Institute of Computer Science, N. Plastira 100, Heraklion, 70013, Greece, 30 2810391449, kondylak@ics.forth.gr %K mobile apps %K systematic survey %K COVID-19 %K mobile health %K eHealth %D 2020 %7 9.12.2020 %9 Review %J J Med Internet Res %G English %X Background: A vast amount of mobile apps have been developed during the past few months in an attempt to “flatten the curve” of the increasing number of COVID-19 cases. Objective: This systematic review aims to shed light into studies found in the scientific literature that have used and evaluated mobile apps for the prevention, management, treatment, or follow-up of COVID-19. Methods: We searched the bibliographic databases Global Literature on Coronavirus Disease, PubMed, and Scopus to identify papers focusing on mobile apps for COVID-19 that show evidence of their real-life use and have been developed involving clinical professionals in their design or validation. Results: Mobile apps have been implemented for training, information sharing, risk assessment, self-management of symptoms, contact tracing, home monitoring, and decision making, rapidly offering effective and usable tools for managing the COVID-19 pandemic. Conclusions: Mobile apps are considered to be a valuable tool for citizens, health professionals, and decision makers in facing critical challenges imposed by the pandemic, such as reducing the burden on hospitals, providing access to credible information, tracking the symptoms and mental health of individuals, and discovering new predictors. %M 33197234 %R 10.2196/23170 %U http://www.jmir.org/2020/12/e23170/ %U https://doi.org/10.2196/23170 %U http://www.ncbi.nlm.nih.gov/pubmed/33197234 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21572 %T COVID-19 Contact-Tracing Apps: Analysis of the Readability of Privacy Policies %A Zhang,Melvyn %A Chow,Aloysius %A Smith,Helen %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road Level 18, Clinical Sciences Building, Singapore, 308322, Singapore, 65 63892504, melvynzhangweibin@gmail.com %K COVID-19 %K smartphone apps %K contact tracing %K privacy policy %K readability %K app %K privacy %K surveillance %D 2020 %7 3.12.2020 %9 Viewpoint %J J Med Internet Res %G English %X Apps that enable contact-tracing are instrumental in mitigating the transmission of COVID-19, but there have been concerns among users about the data collected by these apps and their management. Contact tracing is of paramount importance when dealing with a pandemic, as it allows for rapid identification of cases based on the information collected from infected individuals about other individuals they may have had recent contact with. Advances in digital technology have enabled devices such as mobile phones to be used in the contract-tracing process. However, there is a potential risk of users’ personal information and sensitive data being stolen should hackers be in the near vicinity of these devices. Thus, there is a need to develop privacy-preserving apps. Meanwhile, privacy policies that outline the risk associated with the use of contact-tracing apps are needed, in formats that are easily readable and comprehensible by the public. To our knowledge, no previous study has examined the readability of privacy policies of contact-tracings apps. Therefore, we performed a readability analysis to evaluate the comprehensibility of privacy policies of 7 contact-tracing apps currently in use. The contents of the privacy policies of these apps were assessed for readability using Readability Test Tool, a free web-based reliability calculator, which computes scores based on a number of statistics (ie, word count and the number of complex words) and indices (ie, Flesch Reading Ease, Flesch-Kincaid Reading Grade Level, Gunning Fog Index, and Simplified Measure of Gobbledygook index). Our analysis revealed that explanations used in the privacy policies of these apps require a reading grade between 7 and 14, which is considerably higher than the reading ability of the average individual. We believe that improving the readability of privacy policies of apps could be potentially reassuring for users and may help facilitate the increased use of such apps. %M 33170798 %R 10.2196/21572 %U https://www.jmir.org/2020/12/e21572 %U https://doi.org/10.2196/21572 %U http://www.ncbi.nlm.nih.gov/pubmed/33170798 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e22098 %T Evaluation of the Design and Implementation of a Peer-To-Peer COVID-19 Contact Tracing Mobile App (COCOA) in Japan %A Nakamoto,Ichiro %A Jiang,Ming %A Zhang,Jilin %A Zhuang,Weiqing %A Guo,Yan %A Jin,Ming-Hui %A Huang,Yi %A Tang,Kuotai %+ School of Internet Economics and Business, Fujian University of Technology, 999 Dongsanhuang Road, JinAn District, Fuzhou, China, 86 059183503931, ichiro2019@163.com %K COVID-19 %K contact tracing %K mobile app %K peer-to-peer %K Bluetooth-based %K telehealth %K privacy protection %K load balancing %K close contact %K decentralized %D 2020 %7 1.12.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X We evaluate a Bluetooth-based mobile contact-confirming app, COVID-19 Contact-Confirming Application (COCOA), which is being used in Japan to contain the spread of COVID-19, the disease caused by the novel virus termed SARS-COV-2. The app prioritizes the protection of users’ privacy from a variety of parties (eg, other users, potential attackers, and public authorities), enhances the capacity to balance the current load of excessive pressure on health care systems (eg, local triage of exposure risk and reduction of in-person hospital visits), increases the speed of responses to the pandemic (eg, automated recording of close contact based on proximity), and reduces operation errors and population mobility. The peer-to-peer framework of COCOA is intended to provide the public with dynamic and credible updates on the COVID-19 pandemic without sacrificing the privacy of their information. However, cautions must be exercised to address critical concerns, such as the rate of participation and delays in data sharing. The results of a simulation imply that the participation rate in Japan needs to be close 90% to effectively control the spread of COVID-19. %M 33170801 %R 10.2196/22098 %U https://mhealth.jmir.org/2020/12/e22098 %U https://doi.org/10.2196/22098 %U http://www.ncbi.nlm.nih.gov/pubmed/33170801 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e23194 %T COVID-19 Contact Tracing Apps: A Technologic Tower of Babel and the Gap for International Pandemic Control %A Du,Li %A Raposo,Vera Lúcia %A Wang,Meng %+ Faculty of Law, University of Macau, Avenida da Universidade, Taipa, Macau, SAR, 999078, China, 853 88224733, stephendu@um.edu.mo %K COVID-19 %K contact tracing apps %K privacy %K public health %K global health %D 2020 %7 27.11.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X As the world struggles with the new COVID-19 pandemic, contact tracing apps of various types have been adopted in many jurisdictions for combating the spread of the SARS-CoV-2 virus. However, even if they are successful in containing the virus within national borders, these apps are becoming ineffective as international travel is gradually resumed. The problem rests in the plurality of apps and their inability to operate in a synchronized manner, as well as the absence of an international entity with the power to coordinate and analyze the information collected by the disparate apps. The risk of creating a useless Tower of Babel of COVID-19 contact tracing apps is very real, endangering global health. This paper analyzes legal barriers for realizing the interoperability of contact tracing apps and emphasizes the need for developing coordinated solutions to promote safe international travel and global pandemic control. %M 33156804 %R 10.2196/23194 %U http://mhealth.jmir.org/2020/11/e23194/ %U https://doi.org/10.2196/23194 %U http://www.ncbi.nlm.nih.gov/pubmed/33156804 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e19836 %T Standalone Smartphone Cognitive Behavioral Therapy–Based Ecological Momentary Interventions to Increase Mental Health: Narrative Review %A Marciniak,Marta Anna %A Shanahan,Lilly %A Rohde,Judith %A Schulz,Ava %A Wackerhagen,Carolin %A Kobylińska,Dorota %A Tuescher,Oliver %A Binder,Harald %A Walter,Henrik %A Kalisch,Raffael %A Kleim,Birgit %+ University of Zurich, Psychiatric University Hospital, Lenggstrasse 31, Zurich, 8032, Switzerland, 41 44 384 23 51, birgit.kleim@uzh.ch %K mHealth %K mobile app %K ecological momentary intervention %K EMI %K cognitive behavioral therapy %K CBT %K COVID-19 %K mobile phone %K smartphone %D 2020 %7 12.11.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: A growing number of psychological interventions are delivered via smartphones with the aim of increasing the efficacy and effectiveness of these treatments and providing scalable access to interventions for improving mental health. Most of the scientifically tested apps are based on cognitive behavioral therapy (CBT) principles, which are considered the gold standard for the treatment of most mental health problems. Objective: This review investigates standalone smartphone-based ecological momentary interventions (EMIs) built on principles derived from CBT that aim to improve mental health. Methods: We searched the MEDLINE, PsycINFO, EMBASE, and PubMed databases for peer-reviewed studies published between January 1, 2007, and January 15, 2020. We included studies focusing on standalone app-based approaches to improve mental health and their feasibility, efficacy, or effectiveness. Both within- and between-group designs and studies with both healthy and clinical samples were included. Blended interventions, for example, app-based treatments in combination with psychotherapy, were not included. Selected studies were evaluated in terms of their design, that is, choice of the control condition, sample characteristics, EMI content, EMI delivery characteristics, feasibility, efficacy, and effectiveness. The latter was defined in terms of improvement in the primary outcomes used in the studies. Results: A total of 26 studies were selected. The results show that EMIs based on CBT principles can be successfully delivered, significantly increase well-being among users, and reduce mental health symptoms. Standalone EMIs were rated as helpful (mean 70.8%, SD 15.3; n=4 studies) and satisfying for users (mean 72.6%, SD 17.2; n=7 studies). Conclusions: Study quality was heterogeneous, and feasibility was often not reported in the reviewed studies, thus limiting the conclusions that can be drawn from the existing data. Together, the studies show that EMIs may help increase mental health and thus support individuals in their daily lives. Such EMIs provide readily available, scalable, and evidence-based mental health support. These characteristics appear crucial in the context of a global crisis such as the COVID-19 pandemic but may also help reduce personal and economic costs of mental health impairment beyond this situation or in the context of potential future pandemics. %M 33180027 %R 10.2196/19836 %U https://mhealth.jmir.org/2020/11/e19836 %U https://doi.org/10.2196/19836 %U http://www.ncbi.nlm.nih.gov/pubmed/33180027 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e22594 %T Citizen-Centered Mobile Health Apps Collecting Individual-Level Spatial Data for Infectious Disease Management: Scoping Review %A Wirth,Felix Nikolaus %A Johns,Marco %A Meurers,Thierry %A Prasser,Fabian %+ Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany, 49 15773326360, felix-nikolaus.wirth@charite.de %K pandemic %K epidemic %K infectious disease management %K mobile apps %K automated digital contact tracing %K mobility tracking %K outbreak detection %K location-based risk assessment %K public health %K informatics %K app %K infectious disease %K COVID-19 %K review %D 2020 %7 10.11.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The novel coronavirus SARS-CoV-2 rapidly spread around the world, causing the disease COVID-19. To contain the virus, much hope is placed on participatory surveillance using mobile apps, such as automated digital contact tracing, but broad adoption is an important prerequisite for associated interventions to be effective. Data protection aspects are a critical factor for adoption, and privacy risks of solutions developed often need to be balanced against their functionalities. This is reflected by an intensive discussion in the public and the scientific community about privacy-preserving approaches. Objective: Our aim is to inform the current discussions and to support the development of solutions providing an optimal balance between privacy protection and pandemic control. To this end, we present a systematic analysis of existing literature on citizen-centered surveillance solutions collecting individual-level spatial data. Our main hypothesis is that there are dependencies between the following dimensions: the use cases supported, the technology used to collect spatial data, the specific diseases focused on, and data protection measures implemented. Methods: We searched PubMed and IEEE Xplore with a search string combining terms from the area of infectious disease management with terms describing spatial surveillance technologies to identify studies published between 2010 and 2020. After a two-step eligibility assessment process, 27 articles were selected for the final analysis. We collected data on the four dimensions described as well as metadata, which we then analyzed by calculating univariate and bivariate frequency distributions. Results: We identified four different use cases, which focused on individual surveillance and public health (most common: digital contact tracing). We found that the solutions described were highly specialized, with 89% (24/27) of the articles covering one use case only. Moreover, we identified eight different technologies used for collecting spatial data (most common: GPS receivers) and five different diseases covered (most common: COVID-19). Finally, we also identified six different data protection measures (most common: pseudonymization). As hypothesized, we identified relationships between the dimensions. We found that for highly infectious diseases such as COVID-19 the most common use case was contact tracing, typically based on Bluetooth technology. For managing vector-borne diseases, use cases require absolute positions, which are typically measured using GPS. Absolute spatial locations are also important for further use cases relevant to the management of other infectious diseases. Conclusions: We see a large potential for future solutions supporting multiple use cases by combining different technologies (eg, Bluetooth and GPS). For this to be successful, however, adequate privacy-protection measures must be implemented. Technologies currently used in this context can probably not offer enough protection. We, therefore, recommend that future solutions should consider the use of modern privacy-enhancing techniques (eg, from the area of secure multiparty computing and differential privacy). %M 33074833 %R 10.2196/22594 %U http://mhealth.jmir.org/2020/11/e22594/ %U https://doi.org/10.2196/22594 %U http://www.ncbi.nlm.nih.gov/pubmed/33074833 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e19665 %T A Patient Self-Checkup App for COVID-19: Development and Usage Pattern Analysis %A Heo,JoonNyung %A Sung,MinDong %A Yoon,Sangchul %A Jang,Jinkyu %A Lee,Wonwoo %A Han,Deokjae %A Kim,Hyung-Jun %A Kim,Han-Kyeol %A Han,Ji Hyuk %A Seog,Woong %A Ha,Beomman %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 222282493, yurangpark@yuhs.ac %K COVID-19 %K mobile app %K smartphone %K mobile phone %K self-checkup %D 2020 %7 6.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Clear guidelines for a patient with suspected COVID-19 infection are unavailable. Many countries rely on assessments through a national hotline or telecommunications, but this only adds to the burden of an already overwhelmed health care system. In this study, we developed an algorithm and a web application to help patients get screened. Objective: This study aims to aid the general public by developing a web-based application that helps patients decide when to seek medical care during a novel disease outbreak. Methods: The algorithm was developed via consultations with 6 physicians who directly screened, diagnosed, and/or treated patients with COVID-19. The algorithm mainly focused on when to test a patient in order to allocate limited resources more efficiently. The application was designed to be mobile-friendly and deployed on the web. We collected the application usage pattern data from March 1 to March 27, 2020. We evaluated the association between the usage pattern and the numbers of COVID-19 confirmed, screened, and mortality cases by access location and digital literacy by age group. Results: The algorithm used epidemiological factors, presence of fever, and other symptoms. In total, 83,460 users accessed the application 105,508 times. Despite the lack of advertisement, almost half of the users accessed the application from outside of Korea. Even though the digital literacy of the 60+ years age group is half of that of individuals in their 50s, the number of users in both groups was similar for our application. Conclusions: We developed an expert-opinion–based algorithm and web-based application for screening patients. This innovation can be helpful in circumstances where information on a novel disease is insufficient and may facilitate efficient medical resource allocation. %M 33079692 %R 10.2196/19665 %U https://www.jmir.org/2020/11/e19665 %U https://doi.org/10.2196/19665 %U http://www.ncbi.nlm.nih.gov/pubmed/33079692 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e23081 %T Concerns and Misconceptions About the Australian Government’s COVIDSafe App: Cross-Sectional Survey Study %A Thomas,Rae %A Michaleff,Zoe A %A Greenwood,Hannah %A Abukmail,Eman %A Glasziou,Paul %+ Institute for Evidence-Based Healthcare, Bond University, University Drive, Robina, 4229, Australia, 61 5595 5521, rthomas@bond.edu.au %K health %K policy %K COVID-19 %K digital tracing app %K COVIDSafe %D 2020 %7 4.11.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Timely and effective contact tracing is an essential public health measure for curbing the transmission of COVID-19. App-based contact tracing has the potential to optimize the resources of overstretched public health departments. However, its efficiency is dependent on widespread adoption. Objective: This study aimed to investigate the uptake of the Australian Government’s COVIDSafe app among Australians and examine the reasons why some Australians have not downloaded the app. Methods: An online national survey, with representative quotas for age and gender, was conducted between May 8 and May 11, 2020. Participants were excluded if they were a health care professional or had been tested for COVID-19. Results: Of the 1802 potential participants contacted, 289 (16.0%) were excluded prior to completing the survey, 13 (0.7%) declined, and 1500 (83.2%) participated in the survey. Of the 1500 survey participants, 37.3% (n=560) had downloaded the COVIDSafe app, 18.7% (n=280) intended to do so, 27.7% (n=416) refused to do so, and 16.3% (n=244) were undecided. Equally proportioned reasons for not downloading the app included privacy (165/660, 25.0%) and technical concerns (159/660, 24.1%). Other reasons included the belief that social distancing was sufficient and the app was unnecessary (111/660, 16.8%), distrust in the government (73/660, 11.1%), and other miscellaneous responses (eg, apathy and following the decisions of others) (73/660, 11.1%). In addition, knowledge about COVIDSafe varied among participants, as some were confused about its purpose and capabilities. Conclusions: For the COVIDSafe app to be accepted by the public and used correctly, public health messages need to address the concerns of citizens, specifically privacy, data storage, and technical capabilities. Understanding the specific barriers preventing the uptake of contact tracing apps provides the opportunity to design targeted communication strategies aimed at strengthening public health initiatives, such as downloading and correctly using contact tracing apps. %M 33048826 %R 10.2196/23081 %U http://publichealth.jmir.org/2020/4/e23081/ %U https://doi.org/10.2196/23081 %U http://www.ncbi.nlm.nih.gov/pubmed/33048826 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e23148 %T Performance of Digital Contact Tracing Tools for COVID-19 Response in Singapore: Cross-Sectional Study %A Huang,Zhilian %A Guo,Huiling %A Lee,Yee-Mun %A Ho,Eu Chin %A Ang,Hou %A Chow,Angela %+ Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore, 65 63577477, angela_chow@ttsh.com.sg %K infectious disease %K real-time locating systems %K electronic medical records %K COVID-19 %K contact tracing %K public health %D 2020 %7 29.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective contact tracing is labor intensive and time sensitive during the COVID-19 pandemic, but also essential in the absence of effective treatment and vaccines. Singapore launched the first Bluetooth-based contact tracing app—TraceTogether—in March 2020 to augment Singapore’s contact tracing capabilities. Objective: This study aims to compare the performance of the contact tracing app—TraceTogether—with that of a wearable tag-based real-time locating system (RTLS) and to validate them against the electronic medical records at the National Centre for Infectious Diseases (NCID), the national referral center for COVID-19 screening. Methods: All patients and physicians in the NCID screening center were issued RTLS tags (CADI Scientific) for contact tracing. In total, 18 physicians were deployed to the NCID screening center from May 10 to May 20, 2020. The physicians activated the TraceTogether app (version 1.6; GovTech) on their smartphones during shifts and urged their patients to use the app. We compared patient contacts identified by TraceTogether and those identified by RTLS tags within the NCID vicinity during physicians’ 10-day posting. We also validated both digital contact tracing tools by verifying the physician-patient contacts with the electronic medical records of 156 patients who attended the NCID screening center over a 24-hour time frame within the study period. Results: RTLS tags had a high sensitivity of 95.3% for detecting patient contacts identified either by the system or TraceTogether while TraceTogether had an overall sensitivity of 6.5% and performed significantly better on Android phones than iPhones (Android: 9.7%, iPhone: 2.7%; P<.001). When validated against the electronic medical records, RTLS tags had a sensitivity of 96.9% and specificity of 83.1%, while TraceTogether only detected 2 patient contacts with physicians who did not attend to them. Conclusions: TraceTogether had a much lower sensitivity than RTLS tags for identifying patient contacts in a clinical setting. Although the tag-based RTLS performed well for contact tracing in a clinical setting, its implementation in the community would be more challenging than TraceTogether. Given the uncertainty of the adoption and capabilities of contact tracing apps, policy makers should be cautioned against overreliance on such apps for contact tracing. Nonetheless, leveraging technology to augment conventional manual contact tracing is a necessary move for returning some normalcy to life during the long haul of the COVID-19 pandemic. %M 33006944 %R 10.2196/23148 %U http://mhealth.jmir.org/2020/10/e23148/ %U https://doi.org/10.2196/23148 %U http://www.ncbi.nlm.nih.gov/pubmed/33006944 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e22069 %T Smartphone-Enabled, Telehealth-Based Family Conferences in Palliative Care During the COVID-19 Pandemic: Pilot Observational Study %A Wu,Yu-Rui %A Chou,Tzu-Jung %A Wang,Yi-Jen %A Tsai,Jaw-Shiun %A Cheng,Shao-Yi %A Yao,Chien-An %A Peng,Jen-Kuei %A Hu,Wen-Yu %A Chiu,Tai-Yuan %A Huang,Hsien-Liang %+ Department of Family Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei City, 100, Taiwan, 886 2 23123456 ext 66832, tennishuang@gmail.com %K smartphone %K mobile phone %K telehealth %K family conference %K shared decision making %K COVID-19 %K palliative care %K end-of-life care %D 2020 %7 28.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the palliative care setting, infection control measures implemented due to COVID-19 have become barriers to end-of-life care discussions (eg, discharge planning and withdrawal of life-sustaining treatments) between patients, their families, and multidisciplinary medical teams. Strict restrictions in terms of visiting hours and the number of visitors have made it difficult to arrange in-person family conferences. Phone-based telehealth consultations may be a solution, but the lack of nonverbal cues may diminish the clinician-patient relationship. In this context, video-based, smartphone-enabled family conferences have become important. Objective: We aimed to establish a smartphone-enabled telehealth model for palliative care family conferences. Our model integrates principles from the concept of shared decision making (SDM) and the value, acknowledge, listen, understand, and elicit (VALUE) approach. Methods: Family conferences comprised three phases designed according to telehealth implementation guidelines—the previsit, during-visit, and postvisit phases. We incorporated the following SDM elements into the model: “team talk,” “option talk,” and “decision talk.” The model has been implemented at a national cancer treatment center in Taiwan since February 2020. Results: From February to April 2020, 14 telehealth family conferences in the palliative care unit were analyzed. The patients’ mean age was 73 (SD 10.1) years; 6 out of 14 patients (43%) were female and 12 (86%) were married. The primary caregiver joining the conference virtually comprised mostly of spouses and children (n=10, 71%). The majority of participants were terminally ill patients with cancer (n=13, 93%), with the exception of 1 patient with stroke. Consensus on care goals related to discharge planning and withdrawal of life-sustaining treatments was reached in 93% (n=13) of cases during the family conferences. In total, 5 families rated the family conferences as good or very good (36%), whereas 9 were neutral (64%). Conclusions: Smartphone-enabled telehealth for palliative care family conferences with SDM and VALUE integration demonstrated high satisfaction for families. In most cases, it was effective in reaching consensus on care decisions. The model may be applied to other countries to promote quality in end-of-life care in the midst of the COVID-19 pandemic. %M 33021483 %R 10.2196/22069 %U http://mhealth.jmir.org/2020/10/e22069/ %U https://doi.org/10.2196/22069 %U http://www.ncbi.nlm.nih.gov/pubmed/33021483 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e23197 %T Characteristics and Symptoms of App Users Seeking COVID-19–Related Digital Health Information and Remote Services: Retrospective Cohort Study %A Perlman,Amichai %A Vodonos Zilberg,Alina %A Bak,Peter %A Dreyfuss,Michael %A Leventer-Roberts,Maya %A Vurembrand,Yael %A Jeffries,Howard E %A Fisher,Eyal %A Steuerman,Yael %A Namir,Yinat %A Goldschmidt,Yaara %A Souroujon,Daniel %+ K Health Inc, 298 Fifth Avenue, 7th Floor, New York, NY, 10001, United States, 1 616 304 4654, daniel@khealth.ai %K digital health %K remote care %K symptom checker %K telemedicine %K COVID-19 %K symptom %K cohort study %K self-reported %K online tool %D 2020 %7 20.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient-facing digital health tools have been promoted to help patients manage concerns related to COVID-19 and to enable remote care and self-care during the COVID-19 pandemic. It has also been suggested that these tools can help further our understanding of the clinical characteristics of this new disease. However, there is limited information on the characteristics and use patterns of these tools in practice. Objective: The aims of this study are to describe the characteristics of people who use digital health tools to address COVID-19–related concerns; explore their self-reported symptoms and characterize the association of these symptoms with COVID-19; and characterize the recommendations provided by digital health tools. Methods: This study used data from three digital health tools on the K Health app: a protocol-based COVID-19 self-assessment, an artificial intelligence (AI)–driven symptom checker, and communication with remote physicians. Deidentified data were extracted on the demographic and clinical characteristics of adults seeking COVID-19–related health information between April 8 and June 20, 2020. Analyses included exploring features associated with COVID-19 positivity and features associated with the choice to communicate with a remote physician. Results: During the period assessed, 71,619 individuals completed the COVID-19 self-assessment, 41,425 also used the AI-driven symptom checker, and 2523 consulted with remote physicians. Individuals who used the COVID-19 self-assessment were predominantly female (51,845/71,619, 72.4%), with a mean age of 34.5 years (SD 13.9). Testing for COVID-19 was reported by 2901 users, of whom 433 (14.9%) reported testing positive. Users who tested positive for COVID-19 were more likely to have reported loss of smell or taste (relative rate [RR] 6.66, 95% CI 5.53-7.94) and other established COVID-19 symptoms as well as ocular symptoms. Users communicating with a remote physician were more likely to have been recommended by the self-assessment to undergo immediate medical evaluation due to the presence of severe symptoms (RR 1.19, 95% CI 1.02-1.32). Most consultations with remote physicians (1940/2523, 76.9%) were resolved without need for referral to an in-person visit or to the emergency department. Conclusions: Our results suggest that digital health tools can help support remote care and self-management of COVID-19 and that self-reported symptoms from digital interactions can extend our understanding of the symptoms associated with COVID-19. %M 32961527 %R 10.2196/23197 %U http://www.jmir.org/2020/10/e23197/ %U https://doi.org/10.2196/23197 %U http://www.ncbi.nlm.nih.gov/pubmed/32961527 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e21364 %T Syndromic Surveillance Insights from a Symptom Assessment App Before and During COVID-19 Measures in Germany and the United Kingdom: Results From Repeated Cross-Sectional Analyses %A Mehl,Alicia %A Bergey,Francois %A Cawley,Caoimhe %A Gilsdorf,Andreas %+ Department of Epidemiology & Public Health, Ada Health GmbH, Karl-Liebknecht-Str 1, Berlin, 10178, Germany, 49 30 403 67 390, alicia.mehl@ada.com %K epidemiology %K participatory epidemiology %K participatory surveillance %K COVID-19 symptom assessment apps %K symptom checker apps %K syndromic surveillance %K COVID-19 measures %K COVID-19 lockdown %K digital public health %K health effects of COVID-19 measures, infoveillance %D 2020 %7 9.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Unprecedented lockdown measures have been introduced in countries worldwide to mitigate the spread and consequences of COVID-19. Although attention has been focused on the effects of these measures on epidemiological indicators relating directly to the infection, there is increased recognition of their broader health implications. However, assessing these implications in real time is a challenge, due to the limitations of existing syndromic surveillance data and tools. Objective: The aim of this study is to explore the added value of mobile phone app–based symptom assessment tools as real-time health insight providers to inform public health policy makers. Methods: A comparative and descriptive analysis of the proportion of all self-reported symptoms entered by users during an assessment within the Ada app in Germany and the United Kingdom was conducted between two periods, namely before and after the implementation of “Phase One” COVID-19 measures. Additional analyses were performed to explore the association between symptom trends and seasonality, and symptom trends and weather. Differences in the proportion of unique symptoms between the periods were analyzed using a Pearson chi-square test and reported as log2 fold changes. Results: Overall, 48,300-54,900 symptomatic users reported 140,500-170,400 symptoms during the Baseline and Measures periods in Germany. Overall, 34,200-37,400 symptomatic users in the United Kingdom reported 112,100-131,900 symptoms during the Baseline and Measures periods. The majority of symptomatic users were female (Germany: 68,600/103,200, 66.52%; United Kingdom: 51,200/71,600, 72.74%). The majority were aged 10-29 years (Germany: 68,500/100,000, 68.45%; United Kingdom: 50,900/68,800, 73.91%), and about one-quarter were aged 30-59 years (Germany: 26,200/100,000, 26.15%; United Kingdom: 14,900/68,800, 21.65%). Overall, 103 symptoms were reported either more or less frequently (with statistically significant differences) during the Measures period as compared to the Baseline period, and 34 of these were reported in both countries. The following mental health symptoms (log2 fold change, P value) were reported less often during the Measures period: inability to manage constant stress and demands at work (–1.07, P<.001), memory difficulty (–0.56, P<.001), depressed mood (–0.42, P<.001), and impaired concentration (–0.46, P<.001). Diminished sense of taste (2.26, P<.001) and hyposmia (2.20, P<.001) were reported more frequently during the Measures period. None of the 34 symptoms were found to be different between the same dates in 2019. In total, 14 of the 34 symptoms had statistically significant associations with weather variables. Conclusions: Symptom assessment apps have an important role to play in facilitating improved understanding of the implications of public health policies such as COVID-19 lockdown measures. Not only do they provide the means to complement and cross-validate hypotheses based on data collected through more traditional channels, they can also generate novel insights through a real-time syndromic surveillance system. %M 32997640 %R 10.2196/21364 %U http://mhealth.jmir.org/2020/10/e21364/ %U https://doi.org/10.2196/21364 %U http://www.ncbi.nlm.nih.gov/pubmed/32997640 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e20741 %T COVID-19 Contact Tracing Apps: Predicted Uptake in the Netherlands Based on a Discrete Choice Experiment %A Jonker,Marcel %A de Bekker-Grob,Esther %A Veldwijk,Jorien %A Goossens,Lucas %A Bour,Sterre %A Rutten-Van Mölken,Maureen %+ Erasmus School of Health Policy & Management, Erasmus University Rotterdam, , Rotterdam, Netherlands, 31 10 408 8555, marcel@mfjonker.com %K COVID-19 %K discrete choice experiment %K contact tracing %K participatory epidemiology %K participatory surveillance %K app %K uptake %K prediction %K smartphone %K transmission %K privacy %K mobile phone %D 2020 %7 9.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone-based contact tracing apps can contribute to reducing COVID-19 transmission rates and thereby support countries emerging from lockdowns as restrictions are gradually eased. Objective: The primary objective of our study is to determine the potential uptake of a contact tracing app in the Dutch population, depending on the characteristics of the app. Methods: A discrete choice experiment was conducted in a nationally representative sample of 900 Dutch respondents. Simulated maximum likelihood methods were used to estimate population average and individual-level preferences using a mixed logit model specification. Individual-level uptake probabilities were calculated based on the individual-level preference estimates and subsequently aggregated into the sample as well as subgroup-specific contact tracing app adoption rates. Results: The predicted app adoption rates ranged from 59.3% to 65.7% for the worst and best possible contact tracing app, respectively. The most realistic contact tracing app had a predicted adoption of 64.1%. The predicted adoption rates strongly varied by age group. For example, the adoption rates of the most realistic app ranged from 45.6% to 79.4% for people in the oldest and youngest age groups (ie, ≥75 years vs 15-34 years), respectively. Educational attainment, the presence of serious underlying health conditions, and the respondents’ stance on COVID-19 infection risks were also correlated with the predicted adoption rates but to a lesser extent. Conclusions: A secure and privacy-respecting contact tracing app with the most realistic characteristics can obtain an adoption rate as high as 64% in the Netherlands. This exceeds the target uptake of 60% that has been formulated by the Dutch government. The main challenge will be to increase the uptake among older adults, who are least inclined to install and use a COVID-19 contact tracing app. %M 32795998 %R 10.2196/20741 %U https://mhealth.jmir.org/2020/10/e20741 %U https://doi.org/10.2196/20741 %U http://www.ncbi.nlm.nih.gov/pubmed/32795998 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e21692 %T Preventing and Addressing the Stress Reactions of Health Care Workers Caring for Patients With COVID-19: Development of a Digital Platform (Be + Against COVID) %A Mira,José Joaquín %A Vicente,María Asunción %A Lopez-Pineda,Adriana %A Carrillo,Irene %A Guilabert,Mercedes %A Fernández,César %A Pérez-Jover,Virtudes %A Martin Delgado,Jimmy %A Pérez-Pérez,Pastora %A Cobos Vargas,Angel %A Astier-Peña,María Pilar %A Martínez-García,Olga Beatriz %A Marco-Gómez,Bárbara %A Abad Bouzán,Cristina %+ Telematics Engineering Area, Miguel Hernández University, Edificio Innova, Elche, 03202, Spain, 34 966658423, c.fernandez@umh.es %K COVID-19 %K pandemic %K internet %K social media %K mobile app %K psychosocial %K support system %K health personnel %K app %D 2020 %7 5.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: COVID-19 became a major public health concern in March 2020. Due to the high rate of hospitalizations for COVID-19 in a short time, health care workers and other involved staff are subjected to a large workload and high emotional distress. Objective: The objective of this study is to develop a digital tool to provide support resources that might prevent and consider acute stress reactions in health care workers and other support staff due to the COVID-19 pandemic. Methods: The contents of the digital platform were created through an evidence-based review and consensus conference. The website was built using the Google Blogger tool. The Android version of the app was developed in the Java and XML languages using Android Studio version 3.6, and the iOS version was developed in the Swift language using Xcode version 11.5. The app was evaluated externally by the Andalusian Agency for Healthcare Quality. Results: We detected the needs and pressing situations of frontline health care workers, and then, we proposed a serial of recommendations and support resources to address them. These resources were redesigned using the feedback received. A website in three different languages (Spanish, English, and Portuguese) and a mobile app were developed with these contents, and the AppSaludable Quality Seal was granted to the app. A specific self-report scale to measure acute stress and additional tools were included to support the health care workforce. This instrument has been used in several Latin American countries and has been adapted considering cultural differences. The resources section of the website was the most visited with 18,516 out of 68,913 (26.9%) visits, and the “Self-Report Acute Stress Scale” was the most visited resource with 6468 out of 18,516 (34.9%) visits. Conclusions: The Be + against COVID platform (website and app) was developed and launched to offer a pool of recommendations and support resources, which were specifically designed to protect the psychological well-being and the work morale of health care workers. This is an original initiative different from the usual psychological assistance hotlines. %M 32936769 %R 10.2196/21692 %U https://mhealth.jmir.org/2020/10/e21692 %U https://doi.org/10.2196/21692 %U http://www.ncbi.nlm.nih.gov/pubmed/32936769 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e23153 %T Association of Social Network Use With Increased Anxiety Related to the COVID-19 Pandemic in Anesthesiology, Intensive Care, and Emergency Medicine Teams: Cross-Sectional Web-Based Survey Study %A Clavier,Thomas %A Popoff,Benjamin %A Selim,Jean %A Beuzelin,Marion %A Roussel,Melanie %A Compere,Vincent %A Veber,Benoit %A Besnier,Emmanuel %+ Department of Anesthesiology and Critical Care, Rouen University Hospital, 1 rue de Germont, Rouen, 76000, France, 33 685656293, thomasclavier76@gmail.com %K social network %K nurse %K physician %K anxiety %K emergency medicine, anesthesiology, critical care medicine %K coronavirus disease 2019 %K mental health %K COVID-19 %D 2020 %7 24.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Critical care teams are on the front line of managing the COVID-19 pandemic, which is stressful for members of these teams. Objective: Our objective was to assess whether the use of social networks is associated with increased anxiety related to the COVID-19 pandemic among members of critical care teams. Methods: We distributed a web-based survey to physicians, residents, registered and auxiliary nurses, and nurse anesthetists providing critical care (anesthesiology, intensive care, or emergency medicine) in several French hospitals. The survey evaluated the respondents’ use of social networks, their sources of information on COVID-19, and their levels of anxiety and information regarding COVID-19 on analog scales from 0 to 10. Results: We included 641 respondents in the final analysis; 553 (86.3%) used social networks, spending a median time of 60 minutes (IQR 30-90) per day on these networks. COVID-19–related anxiety was higher in social network users than in health care workers who did not use these networks (median 6, IQR 5-8 vs median 5, IQR 3-7) in univariate (P=.02) and multivariate (P<.001) analyses, with an average anxiety increase of 10% in social network users. Anxiety was higher among health care workers using social networks to obtain information on COVID-19 than among those using other sources (median 6, IQR 5-8 vs median 6, IQR 4-7; P=.04). Social network users considered that they were less informed about COVID-19 than those who did not use social networks (median 8, IQR 7-9 vs median 7, IQR 6-8; P<.01). Conclusions: Our results suggest that social networks contribute to increased anxiety in critical care teams. To protect their mental health, critical care professionals should consider limiting their use of these networks during the COVID-19 pandemic. %M 32924946 %R 10.2196/23153 %U http://mhealth.jmir.org/2020/9/e23153/ %U https://doi.org/10.2196/23153 %U http://www.ncbi.nlm.nih.gov/pubmed/32924946 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e21653 %T Hospital Epidemics Tracker (HEpiTracker): Description and Pilot Study of a Mobile App to Track COVID-19 in Hospital Workers %A Soriano,Joan B %A Fernández,Esteve %A de Astorza,Álvaro %A Pérez de Llano,Luis A %A Fernández-Villar,Alberto %A Carnicer-Pont,Dolors %A Alcázar-Navarrete,Bernardino %A García,Arturo %A Morales,Aurelio %A Lobo,María %A Maroto,Marcos %A Ferreras,Eloy %A Soriano,Cecilia %A Del Rio-Bermudez,Carlos %A Vega-Piris,Lorena %A Basagaña,Xavier %A Muncunill,Josep %A Cosio,Borja G %A Lumbreras,Sara %A Catalina,Carlos %A Alzaga,José María %A Gómez Quilón,David %A Valdivia,Carlos Alberto %A de Lara,Celia %A Ancochea,Julio %+ Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Planta 6, Servicio de Neumología, Diego de León 62, Madrid, 28006, Spain, +34 915202200, jbsoriano2@gmail.com %K app %K COVID-19 %K coronavirus %K e-medicine %K monitoring %K symptoms %K surveillance %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hospital workers have been the most frequently and severely affected professional group during the COVID-19 pandemic, and have a big impact on transmission. In this context, innovative tools are required to measure the symptoms compatible with COVID-19, the spread of infection, and testing capabilities within hospitals in real time. Objective: We aimed to develop and test an effective and user-friendly tool to identify and track symptoms compatible with COVID-19 in hospital workers. Methods: We developed and pilot tested Hospital Epidemics Tracker (HEpiTracker), a newly designed app to track the spread of COVID-19 among hospital workers. Hospital staff in 9 hospital centers across 5 Spanish regions (Andalusia, Balearics, Catalonia, Galicia, and Madrid) were invited to download the app on their phones and to register their daily body temperature, COVID-19–compatible symptoms, and general health score, as well as any polymerase chain reaction and serological test results. Results: A total of 477 hospital staff participated in the study between April 8 and June 2, 2020. Of note, both health-related (n=329) and non–health-related (n=148) professionals participated in the study; over two-thirds of participants (68.8%) were health workers (43.4% physicians and 25.4% nurses), while the proportion of non–health-related workers by center ranged from 40% to 85%. Most participants were female (n=323, 67.5%), with a mean age of 45.4 years (SD 10.6). Regarding smoking habits, 13.0% and 34.2% of participants were current or former smokers, respectively. The daily reporting of symptoms was highly variable across participating hospitals; although we observed a decline in adherence after an initial participation peak in some hospitals, other sites were characterized by low participation rates throughout the study period. Conclusions: HEpiTracker is an already available tool to monitor COVID-19 and other infectious diseases in hospital workers. This tool has already been tested in real conditions. HEpiTracker is available in Spanish, Portuguese, and English. It has the potential to become a customized asset to be used in future COVID-19 pandemic waves and other environments. Trial Registration: ClinicalTrials.gov NCT04326400; https://clinicaltrials.gov/ct2/show/NCT04326400 %M 32845852 %R 10.2196/21653 %U http://publichealth.jmir.org/2020/3/e21653/ %U https://doi.org/10.2196/21653 %U http://www.ncbi.nlm.nih.gov/pubmed/32845852 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e21845 %T Communication Technology Preferences of Hospitalized and Institutionalized Frail Older Adults During COVID-19 Confinement: Cross-Sectional Survey Study %A Sacco,Guillaume %A Lléonart,Sébastien %A Simon,Romain %A Noublanche,Frédéric %A Annweiler,Cédric %A , %+ Department of Geriatric Medicine and Memory Clinic, University Hospital of Angers, 4 Rue Larey, Angers , France, 33 609733254, yogisacco@gmail.com %K video communication %K telephone %K older adults %K nursing home %K hospital %K confinement %K elderly %K COVID-19 %K communication %K technology %K social isolation %K loneliness %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technological communication methods such as telephone calls and video calls can help prevent social isolation and loneliness in frail older adults during confinement. Objective: Our objectives were to determine which virtual communication method (ie, telephone call or video call) was preferred by confined older hospital patients and nursing home residents and the variables influencing this preference. Methods: The TOVID (Telephony Or Videophony for Isolated elDerly) study was a cross-sectional study that was designed to examine the preference between telephone calls and video calls among frail older adults who were either hospitalized in a geriatric acute care unit or institutionalized in a long-term care and nursing home during the COVID-19 confinement period. Results: A total of 132 older people were surveyed between March 25 and May 11, 2020 (mean age 88.2 years, SD 6.2); 79 (59.8%) were women. Patients hospitalized in the geriatric acute care unit were more able to establish communication independently than residents institutionalized in the long-term care and nursing home (P=.03) and were more satisfied with their communication experiences (P=.02). Overall, older people tended to favor telephone calls (73/132, 55.3%) over video calls (59/132, 44.7%); however, their satisfaction degree was similar regardless of the chosen method (P=.1), with no effect of age (P=.97) or gender (P=.2). In the geriatric acute care unit, the satisfaction degrees were similar for telephone calls (40/41, 98%) and video calls (33/38, 87%) in older patients (P=.10). Conversely, in the long-term care and nursing home, residents were more satisfied with the use of video calls to communicate with their relatives (14/15, 93%) versus the use of telephone calls (6/12, 50%; P=.02). Conclusions: Older people confined to health care settings were able to complete telephone calls more independently than video calls, and they tended to use telephone calls more often than video calls. The satisfaction degrees were similar with both modalities and even greater with video calls among long-term care and nursing home residents when they were given assistance to establish communication. Trial Registration: ClinicalTrials.gov NCT04333849: https://www.clinicaltrials.gov/ct2/show/NCT04333849. %M 32896832 %R 10.2196/21845 %U http://mhealth.jmir.org/2020/9/e21845/ %U https://doi.org/10.2196/21845 %U http://www.ncbi.nlm.nih.gov/pubmed/32896832 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e19796 %T Mobile Health Apps on COVID-19 Launched in the Early Days of the Pandemic: Content Analysis and Review %A Ming,Long Chiau %A Untong,Noorazrina %A Aliudin,Nur Amalina %A Osili,Norliza %A Kifli,Nurolaini %A Tan,Ching Siang %A Goh,Khang Wen %A Ng,Pit Wei %A Al-Worafi,Yaser Mohammed %A Lee,Kah Seng %A Goh,Hui Poh %+ Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Tungku Link Rd, Gadong, BE1410, Brunei Darussalam, 673 2460922 ext 2202, longchiauming@gmail.com %K coronavirus %K mobile medical app %K self-care %K mHealth %K health education %K app %K COVID-19 %K content analysis %D 2020 %7 16.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) app use is a major concern because of the possible dissemination of misinformation that could harm the users. Particularly, it can be difficult for health care professionals to recommend a suitable app for coronavirus disease (COVID-19) education and self-monitoring purposes. Objective: This study aims to analyze and evaluate the contents as well as features of COVID-19 mobile apps. The findings are instrumental in helping health care professionals to identify suitable mobile apps for COVID-19 self-monitoring and education. The results of the mobile apps’ assessment could potentially help mobile app developers improve or modify their existing mobile app designs to achieve optimal outcomes. Methods: The search for the mHealth apps available in the android-based Play Store and the iOS-based App Store was conducted between April 18 and May 5, 2020. The region of the App Store where we performed the search was the United States, and a virtual private network app was used to locate and access COVID-19 mobile apps from all countries on the Google Play Store. The inclusion criteria were apps that are related to COVID-19 with no restriction in language type. The basic features assessment criteria used for comparison were the requirement for free subscription, internet connection, education or advisory content, size of the app, ability to export data, and automated data entry. The functionality of the apps was assessed according to knowledge (information on COVID-19), tracing or mapping of COVID-19 cases, home monitoring surveillance, online consultation with a health authority, and official apps run by health authorities. Results: Of the 223 COVID-19–related mobile apps, only 30 (19.9%) found in the App Store and 28 (44.4%) in the Play Store matched the inclusion criteria. In the basic features assessment, most App Store (10/30, 33.3%) and Play Store (10/28, 35.7%) apps scored 4 out of 7 points. Meanwhile, the outcome of the functionality assessment for most App Store apps (13/30, 43.3%) was a score of 3 compared to android-based apps (10/28, 35.7%), which scored 2 (out of the maximum 5 points). Evaluation of the basic functions showed that 75.0% (n=36) of the 48 included mobile apps do not require a subscription, 56.3% (n=27) provide symptom advice, and 41.7% (n=20) have educational content. In terms of the specific functions, more than half of the included mobile apps are official mobile apps maintained by a health authority for COVID-19 information provision. Around 37.5% (n=18) and 31.3% (n=15) of the mobile apps have tracing or mapping and home monitoring surveillance functions, respectively, with only 17% (n=8) of the mobile apps equipped with an online consultation function. Conclusions: Most iOS-based apps incorporate infographic mapping of COVID-19 cases, while most android-based apps incorporate home monitoring surveillance features instead of providing focused educational content on COVID-19. It is important to evaluate the contents and features of COVID-19 mobile apps to guide users in choosing a suitable mobile app based on their requirements. %M 32609622 %R 10.2196/19796 %U https://mhealth.jmir.org/2020/9/e19796 %U https://doi.org/10.2196/19796 %U http://www.ncbi.nlm.nih.gov/pubmed/32609622 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21956 %T App-Based Tracking of Self-Reported COVID-19 Symptoms: Analysis of Questionnaire Data %A Zens,Martin %A Brammertz,Arne %A Herpich,Juliane %A Südkamp,Norbert %A Hinterseer,Martin %+ Department of Medicine, Kliniken Ostallgaeu-Kaufbeuren, Stadtbleiche 1, Fuessen, 87629, Germany, 49 8362 500 726, martin.zens@me.com %K COVID-19 %K self-reporting %K symptom %K tracking %K app %K surveillance %K distribution %K digital tool %K screening %D 2020 %7 9.9.2020 %9 Short Paper %J J Med Internet Res %G English %X Background: COVID-19 is an infectious disease characterized by various clinical presentations. Knowledge of possible symptoms and their distribution allows for the early identification of infected patients. Objective: To determine the distribution pattern of COVID-19 symptoms as well as possible unreported symptoms, we created an app-based self-reporting tool. Methods: The COVID-19 Symptom Tracker is an app-based daily self-reporting tool. Between April 8 and May 15, 2020, a total of 22,327 individuals installed this app on their mobile device. An initial questionnaire asked for demographic information (age, gender, postal code) and past medical history comprising relevant chronic diseases. The participants were reminded daily to report whether they were experiencing any symptoms and if they had been tested for SARS-CoV-2 infection. Participants who sought health care services were asked additional questions regarding diagnostics and treatment. Participation was open to all adults (≥18 years). The study was completely anonymous. Results: In total, 11,829 (52.98%) participants completed the symptom questionnaire at least once. Of these, 291 (2.46%) participants stated that they had undergone an RT-PCR (reverse transcription-polymerase chain reaction) test for SARS-CoV-2; 65 (0.55%) reported a positive test result and 226 (1.91%) a negative one. The mean number of reported symptoms among untested participants was 0.81 (SD 1.85). Participants with a positive test result had, on average, 5.63 symptoms (SD 2.82). The most significant risk factors were diabetes (odds ratio [OR] 8.95, 95% CI 3.30-22.37) and chronic heart disease (OR 2.85, 95% CI 1.43-5.69). We identified chills, fever, loss of smell, nausea and vomiting, and shortness of breath as the top five strongest predictors for a COVID-19 infection. The odds ratio for loss of smell was 3.13 (95% CI 1.76-5.58). Nausea and vomiting (OR 2.84, 95% CI 1.61-5.00) had been reported as an uncommon symptom previously; however, our data suggest a significant predictive value. Conclusions: Self-reported symptom tracking helps to identify novel symptoms of COVID-19 and to estimate the predictive value of certain symptoms. This aids in the development of reliable screening tools. Clinical screening with a high pretest probability allows for the rapid identification of infections and the cost-effective use of testing resources. Based on our results, we suggest that loss of smell and taste be considered cardinal symptoms; we also stress that diabetes is a risk factor for a highly symptomatic course of COVID-19 infection. %M 32791493 %R 10.2196/21956 %U http://www.jmir.org/2020/9/e21956/ %U https://doi.org/10.2196/21956 %U http://www.ncbi.nlm.nih.gov/pubmed/32791493 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e22321 %T A QR Code–Based Contact Tracing Framework for Sustainable Containment of COVID-19: Evaluation of an Approach to Assist the Return to Normal Activity %A Nakamoto,Ichiro %A Wang,Sheng %A Guo,Yan %A Zhuang,Weiqing %+ School of Internet Economics and Business, Fujian University of Technology, 999 Dongsanhuang Road, JinAn District, Fuzhou , China, 86 132 550 66365, fw107@foxmail.com %K COVID-19 %K coronavirus %K symptom-based %K quick response %K eHealth %K digital health %K telesurveillance %K pandemic %K epidemic %K interoperability %D 2020 %7 7.9.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X We discuss a pandemic management framework using symptom-based quick response (QR) codes to contain the spread of COVID-19. In this approach, symptom-based QR health codes are issued by public health authorities. The codes do not retrieve the location data of the users; instead, two different colors are displayed to differentiate the health status of individuals. The QR codes are officially regarded as electronic certificates of individuals’ health status, and can be used for contact tracing, exposure risk self-triage, self-update of health status, health care appointments, and contact-free psychiatric consultations. This approach can be effectively deployed as a uniform platform interconnecting a variety of responders (eg, individuals, institutions, and public authorities) who are affected by the pandemic, which minimizes the errors of manual operation and the costs of fragmented coordination. At the same time, this approach enhances the promptness, interoperability, credibility, and traceability of containment measures. The proposed approach not only provides a supplemental mechanism for manual control measures but also addresses the partial failures of pandemic management tools in the abovementioned facets. The QR tool has been formally deployed in Fujian, a province located in southeast China that has a population of nearly 40 million people. All individuals aged ≥3 years were officially requested to present their QR code during daily public activities, such as when using public transportation systems, working at institutions, and entering or exiting schools. The deployment of this approach has achieved sizeable containment effects and played remarkable roles in shifting the negative gross domestic product (–6.8%) to a positive value by July 2020. The number of cumulative patients with COVID-19 in this setting was confined to 363, of whom 361 had recovered (recovery rate 99.4%) as of July 12, 2020. A simulation showed that if only partial measures of the framework were followed, the number of cumulative cases of COVID-19 could potentially increase ten-fold. This approach can serve as a reliable solution to counteract the emergency of a public health crisis; as a routine tool to enhance the level of public health; to accelerate the recovery of social activities; to assist decision making for policy makers; and as a sustainable measure that enables scalability. %M 32841151 %R 10.2196/22321 %U http://mhealth.jmir.org/2020/9/e22321/ %U https://doi.org/10.2196/22321 %U http://www.ncbi.nlm.nih.gov/pubmed/32841151 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19338 %T Digital Response During the COVID-19 Pandemic in Saudi Arabia %A Hassounah,Marwah %A Raheel,Hafsa %A Alhefzi,Mohammed %+ Prince Sattam Chair for Epidemiology and Public Health Research, Department of Family and Community Medicine, College of Medicine, King Saud University, Room No. 321/27, Third Floor, Medical Education Department, Riyadh, , Saudi Arabia, 966 556942926, hafsaraheel@yahoo.com %K digital response %K COVID-19 %K Saudi Arabia %K digital health %K containment %K public health %K pandemic %K prevention %D 2020 %7 1.9.2020 %9 Viewpoint %J J Med Internet Res %G English %X Background: The first case of COVID-19 in Saudi Arabia was confirmed on March 3, 2020. Saudi Arabia, like many other countries worldwide, implemented lockdown of most public and private services in response to the pandemic and established population movement restrictions nationwide. With the implementation of these strict mitigation regulations, technology and digital solutions have enabled the provision of essential services. Objective: The aim of this paper is to highlight how Saudi Arabia has used digital technology during the COVID-19 pandemic in the domains of public health, health care services, education, telecommunication, commerce, and risk communication. Methods: We documented the use of digital technology in Saudi Arabia during the pandemic using publicly available official announcements, press briefings and releases, news clips, published data, peer-reviewed literature, and professional discussions. Results: Saudi Arabia’s government and private sectors combined developed and launched approximately 19 apps and platforms that serve public health functions and provide health care services. A detailed account of each is provided. Education processes continued using an established electronic learning infrastructure with a promising direction toward wider adoption in the future. Telecommunication companies exhibited smooth collaboration as well as innovative initiatives to support ongoing efforts. Risk communication activities using social media, websites, and SMS text messaging followed best practice guides. Conclusions: The Saudi Vision 2030 framework, released in 2017, has paved the path for digital transformation. COVID-19 enabled the promotion and testing of this transition. In Saudi Arabia, the use of artificial intelligence in integrating different data sources during future outbreaks could be further explored. Also, decreasing the number of mobile apps and merging their functions could increase and facilitate their use. %M 32790642 %R 10.2196/19338 %U https://www.jmir.org/2020/9/e19338 %U https://doi.org/10.2196/19338 %U http://www.ncbi.nlm.nih.gov/pubmed/32790642 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e20572 %T Adoption of a Contact Tracing App for Containing COVID-19: A Health Belief Model Approach %A Walrave,Michel %A Waeterloos,Cato %A Ponnet,Koen %+ Research Group MIOS, Department of Communication Studies, Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, Antwerp, 2000, Belgium, 32 475459785, michel.walrave@uantwerp.be %K COVID-19 %K SARS-CoV-2 %K health belief model %K contact tracing %K proximity tracing %K privacy %D 2020 %7 1.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: To track and reduce the spread of COVID-19, apps have been developed to identify contact with individuals infected with SARS-CoV-2 and warn those who are at risk of having contracted the virus. However, the effectiveness of these apps depends highly on their uptake by the general population. Objective: The present study investigated factors influencing app use intention, based on the health belief model. In addition, associations with respondents’ level of news consumption and their health condition were investigated. Methods: A survey was administered in Flanders, Belgium, to 1500 respondents, aged 18 to 64 years. Structural equation modeling was used to investigate relationships across the model’s constructs. Results: In total, 48.70% (n=730) of respondents indicated that they intend to use a COVID-19 tracing app. The most important predictor was the perceived benefits of the app, followed by self-efficacy and perceived barriers. Perceived severity and perceived susceptibility were not related to app uptake intention. Moreover, cues to action (ie, individuals’ exposure to [digital] media content) were positively associated with app use intention. As the respondents’ age increased, their perceived benefits and self-efficacy for app usage decreased. Conclusions: Initiatives to stimulate the uptake of contact tracing apps should enhance perceived benefits and self-efficacy. A perceived barrier for some potential users is privacy concerns. Therefore, when developing and launching an app, clarification on how individuals’ privacy will be protected is needed. To sustain perceived benefits in the long run, supplementary options could be integrated to inform and assist users. %M 32755882 %R 10.2196/20572 %U http://publichealth.jmir.org/2020/3/e20572/ %U https://doi.org/10.2196/20572 %U http://www.ncbi.nlm.nih.gov/pubmed/32755882 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e19857 %T Acceptability of App-Based Contact Tracing for COVID-19: Cross-Country Survey Study %A Altmann,Samuel %A Milsom,Luke %A Zillessen,Hannah %A Blasone,Raffaele %A Gerdon,Frederic %A Bach,Ruben %A Kreuter,Frauke %A Nosenzo,Daniele %A Toussaert,Séverine %A Abeler,Johannes %+ University of Oxford, Manor Road, Oxford, OX1 3UQ, United Kingdom, 44 1865 281440, johannes.abeler@economics.ox.ac.uk %K COVID-19 %K contact tracing %K proximity tracing %K app %K digital %K user acceptability %K mHealth %K epidemiology %D 2020 %7 28.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic is the greatest public health crisis of the last 100 years. Countries have responded with various levels of lockdown to save lives and stop health systems from being overwhelmed. At the same time, lockdowns entail large socioeconomic costs. One exit strategy under consideration is a mobile phone app that traces the close contacts of those infected with COVID-19. Recent research has demonstrated the theoretical effectiveness of this solution in different disease settings. However, concerns have been raised about such apps because of the potential privacy implications. This could limit the acceptability of app-based contact tracing in the general population. As the effectiveness of this approach increases strongly with app uptake, it is crucial to understand public support for this intervention. Objective: The objective of this study is to investigate the user acceptability of a contact-tracing app in five countries hit by the pandemic. Methods: We conducted a largescale, multicountry study (N=5995) to measure public support for the digital contact tracing of COVID-19 infections. We ran anonymous online surveys in France, Germany, Italy, the United Kingdom, and the United States. We measured intentions to use a contact-tracing app across different installation regimes (voluntary installation vs automatic installation by mobile phone providers) and studied how these intentions vary across individuals and countries. Results: We found strong support for the app under both regimes, in all countries, across all subgroups of the population, and irrespective of regional-level COVID-19 mortality rates. We investigated the main factors that may hinder or facilitate uptake and found that concerns about cybersecurity and privacy, together with a lack of trust in the government, are the main barriers to adoption. Conclusions: Epidemiological evidence shows that app-based contact tracing can suppress the spread of COVID-19 if a high enough proportion of the population uses the app and that it can still reduce the number of infections if uptake is moderate. Our findings show that the willingness to install the app is very high. The available evidence suggests that app-based contact tracing may be a viable approach to control the diffusion of COVID-19. %M 32759102 %R 10.2196/19857 %U http://mhealth.jmir.org/2020/8/e19857/ %U https://doi.org/10.2196/19857 %U http://www.ncbi.nlm.nih.gov/pubmed/32759102 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21613 %T Motivations for Social Distancing and App Use as Complementary Measures to Combat the COVID-19 Pandemic: Quantitative Survey Study %A Kaspar,Kai %+ Department of Psychology, University of Cologne, Richard-Strauss-Str. 2, Cologne, 50931, Germany, 49 221 470 2347, kkaspar@uni-koeln.de %K COVID-19 %K protection motivation theory %K social distancing %K contact tracing app %K data donation app %K social trust %K data security %D 2020 %7 27.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The current COVID-19 pandemic is showing negative effects on human health as well as on social and economic life. It is a critical and challenging task to revive public life while minimizing the risk of infection. Reducing interactions between people by social distancing is an effective and prevalent measure to reduce the risk of infection and spread of the virus within a community. Current developments in several countries show that this measure can be technologically accompanied by mobile apps; meanwhile, privacy concerns are being intensively discussed. Objective: The aim of this study was to examine central cognitive variables that may constitute people’s motivations for social distancing, using an app, and providing health-related data requested by two apps that differ in their direct utility for the individual user. The results may increase our understanding of people’s concerns and convictions, which can then be specifically addressed by public-oriented communication strategies and appropriate political decisions. Methods: This study refers to the protection motivation theory, which is adaptable to both health-related and technology-related motivations. The concept of social trust was added. The quantitative survey included answers from 406 German-speaking participants who provided assessments of data security issues, trust components, and the processes of threat and coping appraisal related to the prevention of SARS-CoV-2 infection by social distancing. With respect to apps, one central focus was on the difference between a contact tracing app and a data donation app. Results: Multiple regression analyses showed that the present model could explain 55% of the interindividual variance in the participants’ motivation for social distancing, 46% for using a contact tracing app, 42% for providing their own infection status to a contact tracing app, and 34% for using a data donation app. Several cognitive components of threat and coping appraisal were related to motivation measurements. Trust in other people’s social distancing behavior and general trust in official app providers also played important roles; however, the participants’ age and gender did not. Motivations for using and accepting a contact tracing app were higher than those for using and accepting a data donation app. Conclusions: This study revealed some important cognitive factors that constitute people’s motivation for social distancing and using apps to combat the COVID-19 pandemic. Concrete implications for future research, public-oriented communication strategies, and appropriate political decisions were identified and are discussed. %M 32759100 %R 10.2196/21613 %U http://www.jmir.org/2020/8/e21613/ %U https://doi.org/10.2196/21613 %U http://www.ncbi.nlm.nih.gov/pubmed/32759100 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20334 %T Features and Functionalities of Smartphone Apps Related to COVID-19: Systematic Search in App Stores and Content Analysis %A Collado-Borrell,Roberto %A Escudero-Vilaplana,Vicente %A Villanueva-Bueno,Cristina %A Herranz-Alonso,Ana %A Sanjurjo-Saez,Maria %+ Hospital General Universitario Gregorio Marañón, C/del Dr. Esquerdo, 46, Madrid, 28007, Spain, 34 678239017, vicente.escudero@salud.madrid.org %K COVID-19 %K mobile apps %K contact tracing %K monitoring %K telemedicine %K smartphone %D 2020 %7 25.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Knowledge of the quantity and quality of apps related to coronavirus disease (COVID-19) is lacking. In addition, no directory has been established listing all the apps developed to address the COVID-19 pandemic. Objective: The aim of this study was to identify smartphone apps designed to address the COVID-19 pandemic and to analyze their characteristics. Methods: We performed an observational, cross-sectional, descriptive study of all smartphone apps associated with COVID-19. Between April 27 and May 2, 2020, we searched the App Store (iOS) and Google Play Store (Android) for COVID-19 apps. The search terms used were coronavirus, COVID-19, and SARS-COV-2. The apps were downloaded and evaluated. The variables analyzed were name, platform, country, language, category, cost, update date, size, version, number of downloads, developer, and purpose. Purpose was further classified into the following categories: news, general information, self-diagnosis, contact tracing, notices to contacts, notification of close cases, awareness, helplines, monitoring of clinical parameters, recording of symptoms and treatment, and messaging with health care professionals. Results: We identified 114 apps on the investigated platforms. Of these, 62/114 (54.4%) were on Android and 52/114 (45.6%) were on iOS. Of the 114 apps, 37 (32.5%) were developed in Europe, 32 (28.1%) in Asia, and 30 (26.3%) in North America. The most frequent languages were English (65/114, 57.0%), Spanish (34/114, 29.8%), and Chinese (14/114, 12.3%). The most common categories were health and well-being/fitness apps (41/114, 41.2%) and medicine apps (43/114, 37.7%). Of the 114 apps, 113 (99.1%) were free. The mean time between the date of the analysis and the date of the last update was 11.1 days (SD 11.0). Overall, 95 of the 114 apps (83.3%) were intended for the general population, 99 apps (7.9%) were intended for health professionals, and 3 apps (2.6%) were intended for both. Regarding the type of developer, 64/114 apps (56.1%) were developed by governments; 42/114 (64.1%) were developed by national governments, and 23/114 (35.9%) were developed by regional governments. The apps with the highest number of downloads (100,000+) were developed by governments (P=.13), except for the World Health Organization app (500,000+). The purposes of the apps available in Western languages (107/114, 93.9%) were determined; the most common purposes were general information about COVID-19 (66, 64.0%), COVID-19 news (53, 51.0%), recording of symptoms (53, 51.0%), and contact tracing (51, 47.7%). More than one purpose was identified for 99/107 apps (92.5%). Conclusions: This paper offers a comprehensive and unique review of all available COVID-19 apps. Governments have adopted these tools during the pandemic, and more than half of the apps were developed by government agencies. The most common purposes of the apps are providing information on the numbers of infected, recovered, and deceased patients, recording of symptoms, and contact tracing. %M 32614777 %R 10.2196/20334 %U https://www.jmir.org/2020/8/e20334 %U https://doi.org/10.2196/20334 %U http://www.ncbi.nlm.nih.gov/pubmed/32614777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19706 %T Digital Tools to Ameliorate Psychological Symptoms Associated With COVID-19: Scoping Review %A Zhang,Melvyn %A Smith,Helen Elizabeth %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Level 11, Family Medicine and Primary Care, 308322, Singapore, 65 98556631, melvynzhangweibin@gmail.com %K COVID-19 %K digital tool %K psychiatry %K mental health %K digital health %K psychology %K distress %K stress %K anxiety %K depression %D 2020 %7 21.8.2020 %9 Review %J J Med Internet Res %G English %X Background: In the four months after the discovery of the index case of coronavirus disease (COVID-19), several studies highlighted the psychological impact of COVID-19 on frontline health care workers and on members of the general public. It is evident from these studies that individuals experienced elevated levels of anxiety and depression in the acute phase, when they first became aware of the pandemic, and that the psychological distress persisted into subsequent weeks. It is becoming apparent that technological tools such as SMS text messages, web-based interventions, mobile interventions, and conversational agents can help ameliorate psychological distress in the workplace and in society. To our knowledge, there are few publications describing how digital tools have been used to ameliorate psychological symptoms among individuals. Objective: The aim of this review was to identify existing SMS text message, web-based, mobile, and conversational agents that the general public can access to ameliorate the psychological symptoms they are experiencing during the COVID-19 pandemic. Methods: To identify digital tools that were published specifically for COVID-19, a search was performed in the PubMed and MEDLINE databases from the inception of the databases through June 17, 2020. The following search strings were used: “NCOV OR 2019-nCoV OR SARS-CoV-2 OR Coronavirus OR COVID19 OR COVID” and “mHealth OR eHealth OR text”. Another search was conducted in PubMed and MEDLINE to identify existing digital tools for depression and anxiety disorders. A web-based search engine (Google) was used to identify if the cited web-based interventions could be accessed. A mobile app search engine, App Annie, was used to determine if the identified mobile apps were commercially available. Results: A total of 6 studies were identified. Of the 6 identified web-based interventions, 5 websites (83%) could be accessed. Of the 32 identified mobile interventions, 7 apps (22%) could be accessed. Of the 7 identified conversational agents, only 2 (29%) could be accessed. Results: A total of 6 studies were identified. Of the 6 identified web-based interventions, 5 websites (83%) could be accessed. Of the 32 identified mobile interventions, 7 apps (22%) could be accessed. Of the 7 identified conversational agents, only 2 (29%) could be accessed. Conclusions: The COVID-19 pandemic has caused significant psychological distress. Digital tools that are commercially available may be useful for at-risk individuals or individuals with pre-existing psychiatric symptoms. %M 32721922 %R 10.2196/19706 %U http://www.jmir.org/2020/8/e19706/ %U https://doi.org/10.2196/19706 %U http://www.ncbi.nlm.nih.gov/pubmed/32721922 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e20025 %T Using mHealth to Increase the Reach of Local Guidance to Health Professionals as Part of an Institutional Response Plan to the COVID-19 Outbreak: Usage Analysis Study %A Windisch,Olivier %A Zamberg,Ido %A Zanella,Marie-Céline %A Gayet-Ageron,Angèle %A Blondon,Katherine %A Schiffer,Eduardo %A Agoritsas,Thomas %+ Division of Urology, Department of Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland, 41 79 777 78 89, olivier.windisch@hcuge.ch %K COVID-19 %K smartphone %K mHealth %K information dissemination %K health professionals %K health administration %K health apps %D 2020 %7 19.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The ongoing coronavirus disease (COVID-19) pandemic forced health jurisdictions worldwide to significantly restructure and reorganize their medical activities. In response to the rapidly evolving body of evidence, a solid communication strategy is needed to increase the reach of and adherence to locally drafted and validated guidance to aide medical staff with COVID-19–related clinical decisions. Objective: We present a usage analysis of a dedicated mobile health (mHealth) platform as part of an institutional knowledge dissemination strategy of COVID-19–related guidance to all health care workers (HCWs) in a large academic hospital. Methods: A multidisciplinary team of experts drafted local guidance related to COVID-19. In total, 60 documents and 17 external links were made available through the platform. Documents were disseminated using a recently deployed mHealth platform for HCWs. Targeted dissemination of COVID-19–related content began on March 22, 2020. Using a third-party statistics tool, data concerning user activity and content use was anonymously collected. A quantitative analysis of user activity was performed over a 4-month period, separated into 3 periods: 2 months before (Period A), 2 weeks after (Period B), and 6 weeks following (Period C) targeted dissemination. Regional epidemiological data (daily new COVID-19 cases and total COVID-19–related hospitalizations) was extracted from an official registry. Results: During the study period, the platform was downloaded by 1233 new users. Consequently, the total number of users increased from 1766 users before Period A to a total of 2999 users at the end of Period C. We observed 27,046 document views, of which 12,728 (47.1%) were COVID-19–related. The highest increase in activity occurred in Period B, rapidly following targeted dissemination, with 7740 COVID-19–related content views, representing 71.2% of total content views within the abovementioned period and 550 daily views of COVID-19–related documents. Total documents consulted per day increased from 117 (IQR 74-160) to 657 (IQR 481-1051), P<.001. This increase in activity followed the epidemiological curbing of newly diagnosed COVID-19 cases, which peaked during Period B. Total active devices doubled from 684 to 1400, daily user activity increased fourfold, and the number of active devices rose from 53 (IQR 40-70) to 210 (IQR 167-297), P<.001. In addition, the number of sessions per day rose from 166 (IQR 110-246) to 704 (IQR 517-1028), P<.001. A persistent but reduced increase in total documents consulted per day (172 [IQR 131-251] versus 117 [IQR 74-160], P<.001) and active devices (71 [IQR 64-89] versus 53 [IQR 40-70]) was observed in Period C compared to Period A, while only 29.8% of the content accessed was COVID-19–related. After targeted dissemination, an immediate increase in activity was observed after push notifications were sent to users. Conclusions: The use of an mHealth solution to disseminate time-sensitive medical knowledge seemed to be an effective solution to increase the reach of validated content to a targeted audience. %M 32749996 %R 10.2196/20025 %U http://mhealth.jmir.org/2020/8/e20025/ %U https://doi.org/10.2196/20025 %U http://www.ncbi.nlm.nih.gov/pubmed/32749996 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e20596 %T Mobile Health Apps That Help With COVID-19 Management: Scoping Review %A John Leon Singh,Hanson %A Couch,Danielle %A Yap,Kevin %+ Department of Public Health, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Building, Melbourne, 3086, Australia, 61 3 9479 6068, kevinyap.ehealth@gmail.com %K COVID-19 %K mobile apps %K mHealth %K contact tracing %K symptom monitoring %K information provision %K mobile health %D 2020 %7 6.8.2020 %9 Review %J JMIR Nursing %G English %X Background: Mobile health (mHealth) apps have played an important role in mitigating the coronavirus disease (COVID-19) response. However, there is no resource that provides a holistic picture of the available mHealth apps that have been developed to combat this pandemic. Objective: Our aim is to scope the evidence base on apps that were developed in response to COVID-19. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews, literature searches were conducted on Google Search, Google Scholar, and PubMed using the country’s name as keywords and “coronavirus,” “COVID-19,” “nCOV19,” “contact tracing,” “information providing apps,” “symptom tracking,” “mobile apps,” “mobile applications,” “smartphone,” “mobile phone,” and “mHealth.” Countries most affected by COVID-19 and those that first rolled out COVID-19–related apps were included. Results: A total of 46 articles were reviewed from 19 countries, resulting in a total of 29 apps. Among them, 15 (52%) apps were on contact tracing, 7 (24%) apps on quarantine, 7 (24%) on symptom monitoring, and 1 (3%) on information provision. More than half (n=20, 69%) were from governmental sources, only 3 (10%) were from private organizations, and 3 (10%) from universities. There were 6 (21%) apps available on either Android or iOS, and 10 (34%) were available on both platforms. Bluetooth was used in 10 (34%) apps for collecting data, 12 (41%) apps used GPS, and 12 (41%) used other forms of data collection. Conclusions: This review identifies that the majority of COVID-19 apps were for contact tracing and symptom monitoring. However, these apps are effective only if taken up by the community. The sharing of good practices across different countries can enable governments to learn from each other and develop effective strategies to combat and manage this pandemic. %M 32897271 %R 10.2196/20596 %U https://nursing.jmir.org/2020/1/e20596/ %U https://doi.org/10.2196/20596 %U http://www.ncbi.nlm.nih.gov/pubmed/32897271 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e19902 %T Health Observation App for COVID-19 Symptom Tracking Integrated With Personal Health Records: Proof of Concept and Practical Use Study %A Yamamoto,Keiichi %A Takahashi,Tsubasa %A Urasaki,Miwa %A Nagayasu,Yoichi %A Shimamoto,Tomonari %A Tateyama,Yukiko %A Matsuzaki,Keiichi %A Kobayashi,Daisuke %A Kubo,Satoshi %A Mito,Shigeyuki %A Abe,Tatsuya %A Matsuura,Hideo %A Iwami,Taku %+ Information Technology Center, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan, 81 73 441 0901, kyamamo@wakayama-med.ac.jp %K public health informatics %K public health administration %K emerging infectious disease %K preventive medicine %K mobile apps %K contact tracing %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As a counter-cluster measure to prevent the spread of the infectious novel coronavirus disease (COVID-19), an efficient system for health observation outside the hospital is urgently required. Personal health records (PHRs) are suitable for the daily management of physical conditions. Importantly, there are no major differences between the items collected by daily health observation via PHR and the observation of items related to COVID-19. Until now, observations related to COVID-19 have been performed exclusively based on disease-specific items. Therefore, we hypothesize that PHRs would be suitable as a symptom-tracking tool for COVID-19. To this end, we integrated health observation items specific to COVID-19 with an existing PHR-based app. Objective: This study is conducted as a proof-of-concept study in a real-world setting to develop a PHR-based COVID-19 symptom-tracking app and to demonstrate the practical use of health observations for COVID-19 using a smartphone or tablet app integrated with PHRs. Methods: We applied the PHR-based health observation app within an active epidemiological investigation conducted by Wakayama City Public Health Center. At the public health center, a list is made of individuals who have been in close contact with known infected cases (health observers). Email addresses are used by the app when a health observer sends data to the public health center. Each health observer downloads the app and installs it on their smartphone. Self-observed health data are entered daily into the app. These data are then sent via the app by email at a designated time. Localized epidemiological officers can visualize the collected data using a spreadsheet macro and, thus, monitor the health condition of all health observers. Results: We used the app as part of an active epidemiological investigation executed at a public health center. During the investigation, 72 close contacts were discovered. Among them, 57 had adopted the use of the health observation app. Before the introduction of the app, all health observers would have been interviewed by telephone, a slow process that took four epidemiological officers more than 2 hours. After the introduction of the app, a single epidemiological officer can carry out health observations. The app was distributed for free beginning in early March, and by mid-May, it had been used by more than 20,280 users and 400 facilities and organizations across Japan. Currently, health observation of COVID-19 is socially recognized and has become one of the requirements for resuming social activities. Conclusions: Health observation by PHRs for the purpose of improving health management can also be effectively applied as a measure against large-scale infectious diseases. Individual habits of improving awareness of personal health and the use of PHRs for daily health management are powerful armaments against the rapid spread of infectious diseases. Ultimately, similar actions may help to prevent the spread of COVID-19. %M 32568728 %R 10.2196/19902 %U https://mhealth.jmir.org/2020/7/e19902 %U https://doi.org/10.2196/19902 %U http://www.ncbi.nlm.nih.gov/pubmed/32568728 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e19822 %T Using eHealth to Support COVID-19 Education, Self-Assessment, and Symptom Monitoring in the Netherlands: Observational Study %A Timmers,Thomas %A Janssen,Loes %A Stohr,Joep %A Murk,J L %A Berrevoets,M A H %+ Interactive Studios, Huisbergenweg 6, Rosmalen, 5249JR, Netherlands, 31 0650617047, thomas@interactivestudios.nl %K patient education %K COVID-19 %K smartphone %K mobile phone %K self-management %K eHealth %K mHealth %D 2020 %7 23.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The coronavirus disease (COVID-19) situation demands a lot from citizens, health care providers, and governmental institutions. Citizens need to cope with guidelines on social interaction, work, home isolation, and symptom recognition. Additionally, health care providers and policy makers have to cope with unprecedented and unpredictable pressure on the health care system they need to manage. By providing citizens with an app, they always have access to the latest information and can assess their own health. This data could be used to support policy makers and health care providers to get valuable insights in the regional distribution of infection load and health care consumption. Objective: The aim of this observational study is to assess people’s use of an app to support them with COVID-19 education, self-assessment, and monitoring of their own health for a 7-day period. In addition, we aim to assess the usability of this data for health care providers and policy makers by applying it to an interactive map and combining it with hospital data. The secondary outcomes of the study were user’s satisfaction with the information provided in the app, perceived usefulness of the app, health care providers they contacted, and the follow-up actions from this contact. Methods: This observational cohort study was carried out at the nonacademic teaching hospital “Elisabeth Twee Steden” (ETZ) in Tilburg, Netherlands. From April 1, 2020, onwards ETZ offered the COVID-19 education, self-assessment, and symptom tracking diary to their already existing app for patient education and monitoring. Results: Between April 1 and April 20, 2020, a total of 6194 people downloaded the app. The self-assessment functionality was used abundantly to check one’s health status. In total, 5104 people responded to the question about severe symptoms, from which 242 indicated to suffer from severe symptoms. A total of 4929 people responded to the question about mild symptoms, from which 3248 indicated to suffer from these. The data was successfully applied to an interactive map, displaying user demographics and health status. Furthermore, the data was linked to clinical data. App users were satisfied with the information in the app and appreciated the symptom diary functionality. In total, 102 users reached out to a health care provider, leading to 91 contacts. Conclusions: Our study demonstrated the successful implementation and use of an app with COVID-19 education, self-assessment, and a 7-day symptom diary. Data collected with the app were successfully applied to an interactive map. In addition, we were able to link the data to COVID-19 screening results from the hospital’s microbiology laboratory. This data could be used to support policy makers and health care providers to get valuable insights in the regional distribution of infection load and health care consumption. Trial Registration: Netherlands Trial Register NL8501; https://www.trialregister.nl/trial/8501 %M 32516750 %R 10.2196/19822 %U http://mhealth.jmir.org/2020/6/e19822/ %U https://doi.org/10.2196/19822 %U http://www.ncbi.nlm.nih.gov/pubmed/32516750 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e20369 %T Case-Initiated COVID-19 Contact Tracing Using Anonymous Notifications %A Cheng,Weibin %A Hao,Chun %+ Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, 466 Xingangzhong Road, Guangzhou, 510317, China, 86 20 89168139, chwb817@gmail.com %K COVID-19 %K surveillance %K contact tracing %K digital contact tracing %K notification %K anonymous %K labor-saving %K stigma %K privacy protection %D 2020 %7 22.6.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X We discuss the concept of a participatory digital contact notification approach to assist tracing of contacts who are exposed to confirmed cases of coronavirus disease (COVID-19); the approach is simple and affordable for countries with limited access to health care resources and advanced technology. The proposed tool serves as a supplemental contract tracing approach to counteract the shortage of health care staff while providing privacy protection for both cases and contacts. This tool can be deployed on the internet or as a plugin for a smartphone app. Confirmed cases with COVID-19 can use this tool to provide contact information (either email addresses or mobile phone numbers) of close contacts. The system will then automatically send a message to the contacts informing them of their contact status, what this status means, the actions that should follow (eg, self-quarantine, respiratory hygiene/cough etiquette), and advice for receiving early care if they develop symptoms. The name of the sender of the notification message by email or mobile phone can be anonymous or not. The message received by the contact contains no disease information but contains a security code for the contact to log on the platform to retrieve the information. %M 32501802 %R 10.2196/20369 %U http://mhealth.jmir.org/2020/6/e20369/ %U https://doi.org/10.2196/20369 %U http://www.ncbi.nlm.nih.gov/pubmed/32501802 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e19457 %T A New System for Surveillance and Digital Contact Tracing for COVID-19: Spatiotemporal Reporting Over Network and GPS %A Wang,Shaoxiong %A Ding,Shuizi %A Xiong,Li %+ Department of General Surgery, Second Xiangya Hospital, Central South University, No. 139 Renmin Middle Road, Furong District, Changsha, China, 86 13787782059, lixionghn@163.com %K COVID-19 %K China %K mobile health %K mobile phones %K smartphones %K contact tracing %K social media %K spatiotemporal data %K GPS %K disease tracking %K public health %K infectious disease %K virus %D 2020 %7 10.6.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The current pandemic of the coronavirus disease (COVID-19) has highlighted the importance of rapid control of the transmission of infectious diseases. This is particularly important for COVID-19, where many individuals are asymptomatic or have only mild symptoms but can still spread the disease. Current systems for controlling transmission rely on patients to report their symptoms to medical professionals and be able to recall and trace all their contacts from the previous few days. This is unrealistic in the modern world. However, existing smartphone-based GPS and social media technology may provide a suitable alternative. We, therefore, developed a mini-program within the app WeChat. This analyzes data from all users and traces close contacts of all patients. This permits early tracing and quarantine of potential sources of infection. Data from the mini-program can also be merged with other data to predict epidemic trends, calculate individual and population risks, and provide recommendations for individual and population protection action. It may also improve our understanding of how the disease spreads. However, there are a number of unresolved questions about the use of smartphone data for health surveillance, including how to protect individual privacy and provide safeguards against data breaches. %M 32499212 %R 10.2196/19457 %U http://mhealth.jmir.org/2020/6/e19457/ %U https://doi.org/10.2196/19457 %U http://www.ncbi.nlm.nih.gov/pubmed/32499212 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19367 %T Complex Reporting of the COVID-19 Epidemic in the Czech Republic: Use of an Interactive Web-Based App in Practice %A Komenda,Martin %A Bulhart,Vojtěch %A Karolyi,Matěj %A Jarkovský,Jiří %A Mužík,Jan %A Májek,Ondřej %A Šnajdrová,Lenka %A Růžičková,Petra %A Rážová,Jarmila %A Prymula,Roman %A Macková,Barbora %A Březovský,Pavel %A Marounek,Jan %A Černý,Vladimír %A Dušek,Ladislav %+ Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 3, Brno, Czech Republic, 420 725174940, komenda@iba.muni.cz %K coronavirus disease %K COVID-19 %K Czech Republic %K web app %K interactive reporting %K epidemiological overview %K CRISP-DM %K public health %K app %K epidemiology %K virus %K health data %K data mining %K modeling %D 2020 %7 27.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The beginning of the coronavirus disease (COVID-19) epidemic dates back to December 31, 2019, when the first cases were reported in the People’s Republic of China. In the Czech Republic, the first three cases of infection with the novel coronavirus were confirmed on March 1, 2020. The joint effort of state authorities and researchers gave rise to a unique team, which combines methodical knowledge of real-world processes with the know-how needed for effective processing, analysis, and online visualization of data. Objective: Due to an urgent need for a tool that presents important reports based on valid data sources, a team of government experts and researchers focused on the design and development of a web app intended to provide a regularly updated overview of COVID-19 epidemiology in the Czech Republic to the general population. Methods: The cross-industry standard process for data mining model was chosen for the complex solution of analytical processing and visualization of data that provides validated information on the COVID-19 epidemic across the Czech Republic. Great emphasis was put on the understanding and a correct implementation of all six steps (business understanding, data understanding, data preparation, modelling, evaluation, and deployment) needed in the process, including the infrastructure of a nationwide information system; the methodological setting of communication channels between all involved stakeholders; and data collection, processing, analysis, validation, and visualization. Results: The web-based overview of the current spread of COVID-19 in the Czech Republic has been developed as an online platform providing a set of outputs in the form of tables, graphs, and maps intended for the general public. On March 12, 2020, the first version of the web portal, containing fourteen overviews divided into five topical sections, was released. The web portal’s primary objective is to publish a well-arranged visualization and clear explanation of basic information consisting of the overall numbers of performed tests, confirmed cases of COVID-19, COVID-19-related deaths, the daily and cumulative overviews of people with a positive COVID-19 case, performed tests, location and country of infection of people with a positive COVID-19 case, hospitalizations of patients with COVID-19, and distribution of personal protective equipment. Conclusions: The online interactive overview of the current spread of COVID-19 in the Czech Republic was launched on March 11, 2020, and has immediately become the primary communication channel employed by the health care sector to present the current situation regarding the COVID-19 epidemic. This complex reporting of the COVID-19 epidemic in the Czech Republic also shows an effective way to interconnect knowledge held by various specialists, such as regional and national methodology experts (who report positive cases of the disease on a daily basis), with knowledge held by developers of central registries, analysts, developers of web apps, and leaders in the health care sector. %M 32412422 %R 10.2196/19367 %U http://www.jmir.org/2020/5/e19367/ %U https://doi.org/10.2196/19367 %U http://www.ncbi.nlm.nih.gov/pubmed/32412422 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19540 %T Containing COVID-19 Among 627,386 Persons in Contact With the Diamond Princess Cruise Ship Passengers Who Disembarked in Taiwan: Big Data Analytics %A Chen,Chi-Mai %A Jyan,Hong-Wei %A Chien,Shih-Chieh %A Jen,Hsiao-Hsuan %A Hsu,Chen-Yang %A Lee,Po-Chang %A Lee,Chun-Fu %A Yang,Yi-Ting %A Chen,Meng-Yu %A Chen,Li-Sheng %A Chen,Hsiu-Hsi %A Chan,Chang-Chuan %+ Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, No.17, Xuzhou Road, Taipei, 100, Taiwan, 886 233668082, ccchan@ntu.edu.tw %K COVID-19 %K mobile geopositioning %K contact tracing %K proximity tracing %K digital contact tracking %K big data %K public health %K precision public health %K surveillance %K virus %D 2020 %7 5.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Low infection and case-fatality rates have been thus far observed in Taiwan. One of the reasons for this major success is better use of big data analytics in efficient contact tracing and management and surveillance of those who require quarantine and isolation. Objective: We present here a unique application of big data analytics among Taiwanese people who had contact with more than 3000 passengers that disembarked at Keelung harbor in Taiwan for a 1-day tour on January 31, 2020, 5 days before the outbreak of coronavirus disease (COVID-19) on the Diamond Princess cruise ship on February 5, 2020, after an index case was identified on January 20, 2020. Methods: The smart contact tracing–based mobile sensor data, cross-validated by other big sensor surveillance data, were analyzed by the mobile geopositioning method and rapid analysis to identify 627,386 potential contact-persons. Information on self-monitoring and self-quarantine was provided via SMS, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests were offered for symptomatic contacts. National Health Insurance claims big data were linked, to follow-up on the outcome related to COVID-19 among those who were hospitalized due to pneumonia and advised to undergo screening for SARS-CoV-2. Results: As of February 29, a total of 67 contacts who were tested by reverse transcription–polymerase chain reaction were all negative and no confirmed COVID-19 cases were found. Less cases of respiratory syndrome and pneumonia were found after the follow-up of the contact population compared with the general population until March 10, 2020. Conclusions: Big data analytics with smart contact tracing, automated alert messaging for self-restriction, and follow-up of the outcome related to COVID-19 using health insurance data could curtail the resources required for conventional epidemiological contact tracing. %M 32353827 %R 10.2196/19540 %U http://www.jmir.org/2020/5/e19540/ %U https://doi.org/10.2196/19540 %U http://www.ncbi.nlm.nih.gov/pubmed/32353827 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19106 %T Turning the Crisis Into an Opportunity: Digital Health Strategies Deployed During the COVID-19 Outbreak %A Pérez Sust,Pol %A Solans,Oscar %A Fajardo,Joan Carles %A Medina Peralta,Manuel %A Rodenas,Pepi %A Gabaldà,Jordi %A Garcia Eroles,Luis %A Comella,Adrià %A Velasco Muñoz,César %A Sallent Ribes,Josuè %A Roma Monfa,Rosa %A Piera-Jimenez,Jordi %+ Open Evidence Research Group, Universitat Oberta de Catalunya, Av del Tibidabo 39, Barcelona, 08035, Spain, 34 651041515, jpiera@bsa.cat %K digital health %K eHealth %K telemedicine %K COVID-19 %K coronavirus %K SARS-CoV-2 %K public health %K policymaking %D 2020 %7 4.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Digital health technologies offer significant opportunities to reshape current health care systems. From the adoption of electronic medical records to mobile health apps and other disruptive technologies, digital health solutions have promised a better quality of care at a more sustainable cost. However, the widescale adoption of these solutions is lagging behind. The most adverse scenarios often provide an opportunity to develop and test the capacity of digital health technologies to increase the efficiency of health care systems. Catalonia (Northeast Spain) is one of the most advanced regions in terms of digital health adoption across Europe. The region has a long tradition of health information exchange in the public health care sector and is currently implementing an ambitious digital health strategy. In this viewpoint, we discuss the crucial role digital health solutions play during the coronavirus disease (COVID-19) pandemic to support public health policies. We also report on the strategies currently deployed at scale during the outbreak in Catalonia. %M 32339998 %R 10.2196/19106 %U http://publichealth.jmir.org/2020/2/e19106/ %U https://doi.org/10.2196/19106 %U http://www.ncbi.nlm.nih.gov/pubmed/32339998 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e19139 %T COVID-19 Mobile Positioning Data Contact Tracing and Patient Privacy Regulations: Exploratory Search of Global Response Strategies and the Use of Digital Tools in Nigeria %A Ekong,Iniobong %A Chukwu,Emeka %A Chukwu,Martha %+ Department of Computer Information System, Faculty of Information & Communication Technology, University of Malta, PG room A24, Level 0, Msida, MSD 2080, Malta, 356 99330888, nnaemeka_ec@hotmail.com %K COVID-19 %K contact tracing %K Nigeria’s National Data Protection Regulation %K General Data Protection Regulation %K GDPR %K coronavirus %K surveillance %K mHealth %K eHealth %K digital health %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The coronavirus disease (COVID-19) pandemic is the biggest global economic and health challenge of the century. Its effect and impact are still evolving, with deaths estimated to reach 40 million if unchecked. One effective and complementary strategy to slow the spread and reduce the impact is to trace the primary and secondary contacts of confirmed COVID-19 cases using contact tracing technology. Objective: The objective of this paper is to survey strategies for digital contact tracing for the COVID-19 pandemic and to present how using mobile positioning data conforms with Nigeria’s data privacy regulations. Methods: We conducted an exploratory review of current measures for COVID-19 contact tracing implemented around the world. We then analyzed how countries are using mobile positioning data technology to reduce the spread of COVID-19. We made recommendations on how Nigeria can adopt this approach while adhering to the guidelines provided by the National Data Protection Regulation (NDPR). Results: Despite the potential of digital contact tracing, it always conflicts with patient data privacy regulations. We found that Nigeria’s response complies with the NDPR, and that it is possible to leverage call detail records to complement current strategies within the NDPR. Conclusions: Our study shows that mobile position data contact tracing is important for epidemic control as long as it conforms to relevant data privacy regulations. Implementation guidelines will limit data misuse. %M 32310817 %R 10.2196/19139 %U http://mhealth.jmir.org/2020/4/e19139/ %U https://doi.org/10.2196/19139 %U http://www.ncbi.nlm.nih.gov/pubmed/32310817 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e19359 %T COVID-19 Contact Tracing and Data Protection Can Go Together %A Abeler,Johannes %A Bäcker,Matthias %A Buermeyer,Ulf %A Zillessen,Hannah %+ Department of Economics, University of Oxford, Manor Road, Oxford, United Kingdom, 44 1865281440, johannes.abeler@economics.ox.ac.uk %K COVID-19 %K app %K contact tracing %K proximity tracing %K privacy %K data protection %K Bluetooth %D 2020 %7 20.4.2020 %9 Guest Editorial %J JMIR Mhealth Uhealth %G English %X We discuss the implementation of app-based contact tracing to control the coronavirus disease (COVID-19) pandemic and discuss its data protection and user acceptability aspects. %M 32294052 %R 10.2196/19359 %U http://mhealth.jmir.org/2020/4/e19359/ %U https://doi.org/10.2196/19359 %U http://www.ncbi.nlm.nih.gov/pubmed/32294052 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18795 %T A Case for Participatory Disease Surveillance of the COVID-19 Pandemic in India %A Garg,Suneela %A Bhatnagar,Nidhi %A Gangadharan,Navya %+ Maulana Azad Medical College, Delhi University, Bahadur Shah Zafar Marg-02, Delhi, 110002, India, 91 08750647995, bhatnagarnidhi.mamc@gmail.com %K participatory %K surveillance %K COVID-19 %K pandemic %K outbreak %K public health %K infectious disease %K India %D 2020 %7 16.4.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The coronavirus disease pandemic requires the deployment of novel surveillance strategies to curtail further spread of the disease in the community. Participatory disease surveillance mechanisms have already been adopted in countries for the current pandemic. India, with scarce resources, good telecom support, and a not-so-robust heath care system, makes a strong case for introducing participatory disease surveillance for the prevention and control of the pandemic. India has just launched Aarogya Setu, which is a first-of-its-kind participatory disease surveillance initiative in India. This will supplement the existing Integrated Disease Surveillance Programme in India by finding missing cases and having faster aggregation, analysis of data, and prompt response measures. This newly created platform empowers communities with the right information and guidance, enabling protection from infection and reducing unnecessary contact with the overburdened health care system. However, caution needs to be exercised to address participation from digitally isolated populations, ensure the reliability of data, and consider ethical concerns such as maintaining individual privacy. %M 32287038 %R 10.2196/18795 %U http://publichealth.jmir.org/2020/2/e18795/ %U https://doi.org/10.2196/18795 %U http://www.ncbi.nlm.nih.gov/pubmed/32287038 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e18936 %T Peer-to-Peer Contact Tracing: Development of a Privacy-Preserving Smartphone App %A Yasaka,Tyler M %A Lehrich,Brandon M %A Sahyouni,Ronald %+ Department of Otolaryngology – Head and Neck Surgery, University of California, Irvine, 1001 Health Sciences Rd, Irvine, CA, 92617, United States, 1 949 824 5011, yasaka.tyler@gmail.com %K COVID-19 %K smartphone %K privacy %K contact tracing %K peer-to-peer %K epidemic %K personal data %K mobile phone %K coronavirus %K pandemic %D 2020 %7 7.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The novel coronavirus disease 2019 (COVID-19) pandemic is an urgent public health crisis, with epidemiologic models predicting severe consequences, including high death rates, if the virus is permitted to run its course without any intervention or response. Contact tracing using smartphone technology is a powerful tool that may be employed to limit disease transmission during an epidemic or pandemic; yet, contact tracing apps present significant privacy concerns regarding the collection of personal data such as location. Objective: The aim of this study is to develop an effective contact tracing smartphone app that respects user privacy by not collecting location information or other personal data. Methods: We propose the use of an anonymized graph of interpersonal interactions to conduct a novel form of contact tracing and have developed a proof-of-concept smartphone app that implements this approach. Additionally, we developed a computer simulation model that demonstrates the impact of our proposal on epidemic or pandemic outbreak trajectories across multiple rates of adoption. Results: Our proof-of-concept smartphone app allows users to create “checkpoints” for contact tracing, check their risk level based on their past interactions, and anonymously self-report a positive status to their peer network. Our simulation results suggest that higher adoption rates of such an app may result in a better controlled epidemic or pandemic outbreak. Conclusions: Our proposed smartphone-based contact tracing method presents a novel solution that preserves privacy while demonstrating the potential to suppress an epidemic or pandemic outbreak. This app could potentially be applied to the current COVID-19 pandemic as well as other epidemics or pandemics in the future to achieve a middle ground between drastic isolation measures and unmitigated disease spread. %M 32240973 %R 10.2196/18936 %U https://mhealth.jmir.org/2020/4/e18936 %U https://doi.org/10.2196/18936 %U http://www.ncbi.nlm.nih.gov/pubmed/32240973