BACKGROUNDDigital contact tracing apps have been proposed as a method of controlling the spread of Covid-19. The effectiveness of this tool depends largely on adequate levels of uptake (e.g. whether the user downloads and registers on the application) and engagement (e.g. the extent of usage of the application or its components over time). It has been estimated that approximately 60% of the population would need to use the NHSX application in order for it to be effective in reducing the spread of COVID-19. It is therefore crucial that we understand the level of, and factors influencing, uptake and engagement with digital tracing applications in order to put appropriate measures in place to mitigate those issues.AIMS1.To quantify the current data on COVID-19 digital contact tracing applicationsa.Uptake and engagement of COVID-19 digital contact tracing applicationsb.Examine whether uptake differs between countries c.Identify any predictors or correlates of uptake and engagement2.To conduct two scoping reviews to identify key barriers and facilitators influencing engagement and uptake of a.COVID-19 digital contact tracing applications b.Health behaviour change applications, including government approved applications, from academic literature and behaviour change guidelinesCONCLUSIONS•There is no evidence on the level of uptake and engagement with COVID-19 digital contact tracing applications.•There is a dearth of evidence regarding the barriers and facilitators to uptake and engagement with COVID-19 digital contact tracing applications.•The health behaviour change literature suggests a number of barriers and facilitators associated with uptake and engagement with applications.

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Background Several preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes. However, few studies have investigated women’s knowledge of and attitudes towards preconception health, and the acceptability of potential intervention methods. Methods Seven primary care centres in the West of England posted questionnaires to 4330 female patients aged 18 to 48 years. Without providing examples, we asked women to list maternal preconception exposures that might affect infant and maternal outcomes, and assessed their knowledge of nine literature-derived risk factors. Attitudes towards preconception health (interest, intentions, self-efficacy and perceived awareness and importance) and the acceptability of intervention delivery methods were also assessed. Multivariable multilevel regression examined participant characteristics associated with these outcomes. Results Of those who received questionnaires, 835 (19.3%) responded. Women were most aware of the preconception risk factors of diet (86.0%) and physical activity (79.2%). Few were aware of weight (40.1%), folic acid (32.9%), abuse (6.3%), advanced age (5.9%) and interpregnancy intervals (0.2%), and none mentioned interpregnancy weight change or excess iron intake. After adjusting for demographic and reproductive covariates, women aged 18–24-years (compared to 40–48-year-olds) and nulligravid women were less aware of the benefit of preconception folic acid supplementation (adjusted odds ratios (aOR) for age: 4.30 [2.10–8.80], gravidity: aOR 2.48 [1.70–3.62]). Younger women were more interested in learning more about preconception health (aOR 0.37 [0.21–0.63]) but nulligravid women were less interested in this (aOR 1.79 [1.30–2.46]). Women with the lowest household incomes (versus the highest) were less aware of preconception weight as a risk factor (aOR: 3.11 [1.65–5.84]) and rated the importance of preconception health lower (aOR 3.38 [1.90–6.00]). The most acceptable information delivery methods were websites/apps (99.5%), printed healthcare materials (98.6%), family/partners (96.3%), schools (94.4%), television (91.9%), pregnancy tests (91.0%) and doctors, midwives and nurses (86.8–97.0%). Dentists (23.9%) and hairdressers/beauticians (18.1%) were the least acceptable. Conclusions Our findings demonstrate a need to promote awareness of preconception risk factors and motivation for preconception health changes, particularly amongst younger and nulligravid women and women with lower incomes. Interventions to improve preconception health should focus on communication from healthcare professionals, schools, family members, and digital media.

Background: Several preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes. However, few studies have investigated womens knowledge of and attitudes towards preconception health, and the acceptability of potential intervention methods. Methods: Seven GP practices in the West of England posted questionnaires to 4,330 female patients aged 18 to 48. Without providing examples, we asked women to name maternal preconception risk factors. Womens knowledge of nine literature-derived risk factors was then assessed. Attitudes towards preconception health (interest, intentions, self-efficacy and perceived awareness and importance) and the acceptability of intervention delivery methods were also assessed. Multivariable multilevel regression examined participant characteristics associated with these outcomes. Results: Of the 4,330 women who received questionnaires, 835 (19.3%) responded. Women were most aware of the preconception risk factors of diet (86.0%) and physical activity (79.2%). Few were aware of weight (40.1%), folic acid (32.9%), abuse (6.3%); advanced age (5.9%) and interpregnancy intervals (0.2%), and none mentioned interpregnancy weight change or excess iron intake. After adjusting for demographic and reproductive covariates, women aged 18-25-years (compared to 40-48-year-olds) and nulligravid women were less aware of the benefit of preconception folic acid supplementation (adjusted odds ratios (aOR) for age: 4.30 [2.10, 8.80], gravidity: aOR 2.48 [1.70, 3.62]). Younger women were more interested in learning more about preconception health (aOR 0.37 [0.21, 0.63]) but nulligravid women were less interested in this (aOR 1.79 [1.30, 2.46]). Women with the lowest household incomes (versus the highest) were less aware of preconception weight as a risk factor (aOR: 3.11 [1.65, 5.84]) and rated the importance of preconception health lower (aOR 3.38 [1.90, 6.00]). The most acceptable information delivery channels were printed healthcare materials (99.5%), websites/apps (98.6%), family/partners (96.3%), schools (94.4%), television (91.9%), pregnancy tests (91.0%) and doctors, midwives and nurses (86.8-93.5%). Dentists (23.9%) and hairdressers/beauticians (18.1%) were the least acceptable. Conclusions: Our findings demonstrate a need to promote awareness of preconception risk factors and motivation for preconception health changes, particularly amongst younger and nulligravid women and women with lower incomes. Interventions to improve preconception health should focus on communication from healthcare professionals, schools, family members, and digital media.