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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.

BACKGROUND To contain the COVID-19 pandemic, it is essential to trace and contain infection chains, and therefore, policymakers have endorsed the usage of contact tracing apps. To date, over 50 countries have released such apps officially or semi-officially, but those which rely on citizens’ voluntary uptake decisions suffer from low adoption rates, aggravating the effectiveness of the apps. Earlier studies suggest that the low uptake is driven by citizens’ concerns about security and privacy, low perceived infection risk, and low perceived benefit from the usage. However, the association between individuals’ prosociality and uptake decision is largely unexplored. OBJECTIVE The objective of our study is to examine the role of prosociality in encouraging the usage of contact tracing apps and its generational differences in Japan. METHODS An online survey was conducted in Japan six months after the release of a government-sponsored contact tracing app. Participants were recruited from those aged between 20 and 69. Exploratory factor analyses were conducted to measure prosociality, risk perception, and trust in government. A logistic regression was conducted to examine the association between these factors and uptake. RESULTS A total of 7,084 respondents participated in the survey, and 5,402 observations were used for analysis, of which 791 (14.6%) had ever used the app. Two factors of prosociality were retained: agreeableness and attachment to the community. In the full sample analysis, the uptake was determined by agreeableness, attachment to the community, concern about health risks, concern about social risks, and trust in the national government. However, generational differences existed. The uptake decision of those aged between 20 and 39 was attributed to their attachment to the community (OR 1.28, CI 1.11 – 1.48). Agreeable personality (OR 1.18, CI 1.02 – 1.35), concern about social risk (OR 1.17, CI 1.02 – 1.35), and trust in national government (OR 1.16, CI 1.05 – 1.28) were key determinants for those aged between 40 and 59. For those aged over 60, concerns about health risks determined the uptake decision (OR 1.49, CI 1.24 – 1.80). CONCLUSIONS Policymakers should implement different interventions for each generation to increase the adoption rate of the apps. For seniors, it may be effective to inform them about the health benefits from the apps. For the middle-aged, it is important to mitigate their concerns about security and privacy issues. For younger generations, it is necessary to boost their attachment to their community, which is challenging given the requirement of social-distancing during the pandemic. CLINICALTRIAL Not applicable.

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