Background Digital Contact Tracing is seen as a key tool in reducing the propagation of Covid-19. But it requires high uptake and continued participation across the population to be effective. To achieve sufficient uptake/participation, health authorities should address, and thus be aware of, user concerns. Aim This work manually analyzes user reviews of the Irish Heath Service Executive’s (HSE) Contact Tracker app, to identify user concerns and to lay the foundations for subsequent, large-scale, automated analyses of reviews. While this might seem tightly scoped to the Irish context, the HSE app provides the basis for apps in many jurisdictions in the USA and Europe. Methods Manual analysis of (1287) user reviews from the Google/Apple playstores was performed, to identify the aspects of the app that users focused on, and the positive/negative sentiment expressed. Results The findings suggest a largely positive sentiment towards the app, and that users thought it handled data protection and transparency aspects well. But feedback suggests that users would appreciate more targeted feedback on the incidence of the virus, and facilities for more proactive engagement, like notifications that prompt users to submit their health status daily. Finally, the analysis suggests that the “android battery” issue and the backward-compatibility issue with iPhones seriously impacted retention/uptake of the app respectively. Conclusion The HSE have responded to the public’s desire for targeted feedback in newer versions, but should consider increasing the app’s proactive engagement. The results suggest they should also raise the backward compatibility issue, regarding older iPhones, with Apple.

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Background Digital contact tracing apps have the potential to augment contact tracing systems and disrupt COVID-19 transmission by rapidly identifying secondary cases prior to the onset of infectiousness and linking them into a system of quarantine, testing, and health care worker case management. The international experience of digital contact tracing apps during the COVID-19 pandemic demonstrates how challenging their design and deployment are. Objective This study aims to derive and summarize best practice guidance for the design of the ideal digital contact tracing app. Methods A collaborative cross-disciplinary approach was used to derive best practice guidance for designing the ideal digital contact tracing app. A search of the indexed and gray literature was conducted to identify articles describing or evaluating digital contact tracing apps. MEDLINE was searched using a combination of free-text terms and Medical Subject Headings search terms. Gray literature sources searched were the World Health Organization Institutional Repository for Information Sharing, the European Centre for Disease Prevention and Control publications library, and Google, including the websites of many health protection authorities. Articles that were acceptable for inclusion in this evidence synthesis were peer-reviewed publications, cohort studies, randomized trials, modeling studies, technical reports, white papers, and media reports related to digital contact tracing. Results Ethical, user experience, privacy and data protection, technical, clinical and societal, and evaluation considerations were identified from the literature. The ideal digital contact tracing app should be voluntary and should be equitably available and accessible. User engagement could be enhanced by small financial incentives, enabling users to tailor aspects of the app to their particular needs and integrating digital contact tracing apps into the wider public health information campaign. Adherence to the principles of good data protection and privacy by design is important to convince target populations to download and use digital contact tracing apps. Bluetooth Low Energy is recommended for a digital contact tracing app's contact event detection, but combining it with ultrasound technology may improve a digital contact tracing app's accuracy. A decentralized privacy-preserving protocol should be followed to enable digital contact tracing app users to exchange and record temporary contact numbers during contact events. The ideal digital contact tracing app should define and risk-stratify contact events according to proximity, duration of contact, and the infectiousness of the case at the time of contact. Evaluating digital contact tracing apps requires data to quantify app downloads, use among COVID-19 cases, successful contact alert generation, contact alert receivers, contact alert receivers that adhere to quarantine and testing recommendations, and the number of contact alert receivers who subsequently are tested positive for COVID-19. The outcomes of digital contact tracing apps' evaluations should be openly reported to allow for the wider public to review the evaluation of the app. Conclusions In conclusion, key considerations and best practice guidance for the design of the ideal digital contact tracing app were derived from the literature.

Digital Contact Tracing (DCT) is seen as a key tool in reducing the propagation of viruses such as Covid-19, but it requires uptake and participation in the technology across a large proportion of the population to be effective. While we observe the pervasive uptake of mobile device usage across our society, the installation and usage of contact tracing apps developed by governments and health services globally have faced difficulties. These difficulties range across the user-populations’ issues with the installation of the apps, us-ability and comprehension challenges, trust in the efficacy of the technology, performance issues such as the effect on battery life, and concerns about data protection and privacy. In this work, we present our findings from a comprehensive review of the online user feedback relating to the initial release of the HSE Contact Tracker app, in an effort to inform later iterations and thus help sustain and potentially increase usage of the technology. While this might seem quite tightly scoped to the Irish context only, this app provides the basis for apps in many jurisdictions in the United States and Europe. Our findings suggest a largely positive sentiment towards the app, and that users thought it handled data protection and transparency aspects well. But feedback also suggested that users would appreciate more targeted feedback,more proactive engagement and also suggested that both the ‘android-battery’ issue and the backward-compatibility issue with iPhones seriously impacted retention/uptake of the app respectively.