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.

Background eHealth interventions are developed to support and facilitate patients with lifestyle changes and self-care tasks after being diagnosed with a cardiovascular disease (CVD). Creating long-lasting effects on lifestyle change and health outcomes with eHealth interventions is challenging and requires good understanding of patient values. Objective The aim of the study was to identify values of importance to patients with CVD to aid in designing a technological lifestyle platform. Methods A mixed method design was applied, combining data from usability testing with an additional online survey study, to validate the outcomes of the usability tests. Results A total of 11 relevant patient values were identified, including the need for security, support, not wanting to feel anxious, tailoring of treatment, and personalized, accessible care. The validation survey shows that all values but one (value 9: To have extrinsic motivation to accomplish goals or activities [related to health/lifestyle]) were regarded as important/very important. A rating of very unimportant or unimportant was given by less than 2% of the respondents (value 1: 4/641, 0.6%; value 2: 10/641, 1.6%; value 3: 9/641, 1.4%; value 4: 5/641, 0.8%; value 5: 10/641, 1.6%; value 6: 4/641, 0.6%; value 7: 10/639, 1.6%; value 8: 4/639, 0.6%; value 10: 3/636, 0.5%; value 11: 4/636, 0.6%) to all values except but one (value 9: 56/636, 8.8%). Conclusions There is a high consensus among patients regarding the identified values reflecting goals and themes central to their lives, while living with or managing their CVD. The identified values can serve as a foundation for future research to translate and integrate these values into the design of the eHealth technology. This may call for prioritization of values, as not all values can be met equally.

The coronavirus disease (COVID-19) has led to a global pandemic. AQ1 Many countries are using contact tracing as one of the interventions to control virus transmission. In conventional contact tracing, index cases with positive test results are asked to provide contact information of close contacts who were at risk of acquiring infection from the index case, within a given time period before the AQ2 positive test result. Mobile contact tracing apps can augment traditional contact tracing, as they exchange contact information wirelessly and semi-automatically, and allow for quicker warning of at-risk contacts. AQ3 However, little is known about user acceptance and perception of such contact tracing apps, or how people perceive the advice presented therein. In July 2020, the beta version of the official Dutch corona notification app was usability tested with participants from various age groups. This paper presents the results of the objective eye tracking measurements executed during these usability tests. The results show that both health and process related information is easily overlooked in the app by participants. A closed-loop contact with the builders of the app allowed for a direct feedback channel and quick improvements during the development stage.

BACKGROUND Adoption and evaluation of ICT-based contact tracing tools may expand the reach and efficacy of traditional contact tracing methods in fighting COVID-19. The Dutch Ministry of Health, Welfare and Sports (HWS) initiated and developed a COVID-19 contact tracing app: CoronaMelder. This app is based on Google/Apple exposure notification approach and aims to combat the spread of the COVID-19 virus among citizens, by notifying citizens who were at increased risk of infection because they were close by someone who was later tested positive for COVID-19. The app should support the traditional contact tracing by quicker tracing and reaching more people than regular contact tracing procedures. OBJECTIVE The main goal of this study is to investigate whether the CoronaMelder is able to support traditional contact tracing of Public Health Authorities (PHAs). To achieve this, usability tests were conducted aimed at answering the following question: Is the CoronaMelder user-friendly, understandable, reliable and credible, and inclusive? METHODS Participants (n=44) with different backgrounds were recruited: young people with a lower or higher level of education, young people with an intellectual disability, migrants, adults (40-64 years) and elderly (65> years) via convenience sampling in the CoronaMelder test region Twente, The Netherlands. The app was evaluated with scenario-based think-aloud usability tests with additional interviews. Findings were recorded via voice recordings, observation notes, the Dutch User Experience Questionnaire (UEQ-Dutch) and some participants wore eye trackers to measure gaze behavior. RESULTS Our results show that the app is easy to use. Yet, problems occurred with understandability and accessibility. Elderly and young people with a lower level of education do not understand why or when they receive notifications, or why they must share the key, and what happens after sharing. Especially young people with a lower level of education did not trust and understand the Bluetooth signals, timing and follow-up activities after risk exposure notification and elderly had difficulties in multitasking (contact with PHAs simultaneously with sharing key in app). PHAs appeared unprepared to be supported by the app in traditional contact tracing, because their telephone conversation protocol lacks guidance, explanation, and empathy. CONCLUSIONS The study indicated that the app is easy to use, but participants have misconceptions about its functioning. The perceived lack of clarity led to misconceptions of the app, mostly regarding its usefulness or privacy-preserving mechanisms. Tailored and target group specified communication, in forms of public campaigns or social media, is necessary to provide correct information about the app to Dutch citizens. Additionally, the app should be presented as part of the package of national corona measures, instead of just as a stand-alone app provided to the public. To succeed, PHA workers should be trained to effectively and empathically instruct users to warn others by using the CoronaMelder app.

Background Podiatrists are key professionals in promoting adequate foot self-care for people with diabetes at high-risk of developing foot ulcers. However, merely informing patients about the advantages of foot self-care is insufficient to realise behavioural change. Motivational interviewing (MI) is a promising person-centred communication style that could help to create a working alliance between healthcare providers and patient to improve foot self-care. This study aims to observe and analyse the application of MI in consultations carried out by MI-trained and non-MI-trained podiatrists with their patients, and explore podiatrists’ attitudes and experiences towards MI. Methods Eighteen podiatrists (median age: 28.5 years, 10 female and 8 male) followed a three-day basic training in MI and 4 podiatrists (median age: 38.5 years, 4 female) were not trained in MI. To observe and rate the MI-fidelity in daily clinical practice, audio recordings from the MI-trained and non-MI-trained podiatrists were scored with the Motivational Interviewing Treatment Integrity code. Individual, semi-structed, in-depth interviews were conducted with the MI-trained podiatrists to explore their attitudes towards and experiences with MI. These data sources were triangulated to describe the effect of training podiatrists in MI for their clinical practice. Results The MI-trained podiatrists scored significantly higher than the non-MI-trained podiatrists on two of four global MI-related communication skills (empathy, p = 0.008 and change talk, p = 0.008), on one of five core MI-adherent behaviours (affirmation, p = 0.041) and on one of the other behaviour counts (simple reflections, p = 0.008). The podiatrists mainly reported their attitudes and experiences regarding partnership and cultivating change talk, during the interviews. In addition, they also mentioned facilitators and barriers to using MI and indicated whether they experienced MI as having added value. Conclusions The MI-trained podiatrists used the principles of MI at a solid beginner proficiency level in their clinical practice in comparison to the non-MI-trained podiatrists, who did not reach this level. This achievement is in accordance with the basic MI-training they received. This multi-method study reveals that podiatrists can be effectively trained in applying MI in daily clinical practice. Trial registration Netherlands Trial Register NL7710. Registered: 6 May 2019.