Exploring Attitudes and Obstacles around Digital Public Health Tools: Insights from Washington State's Vaccine Verification System (Preprint)

Abstract

BACKGROUND Development and use of digital public health tools surged during the COVID-19 pandemic. Among the tools that aimed to limit disease spread were vaccine verification systems, an alternative to paper vaccine records. In November 2021, the Washington State Department of Health launched “WA Verify”, a QR code-based vaccine verification system based on the SMART Health Card framework, which offered residents a convenient way to store and share proof of vaccination digitally. However, WA Verify was developed and disseminated before assessments of and input from the public regarding potential challenges to its adoption (concerns regarding privacy, surveillance, data sharing, trust in the technology and organizations that manage its use) could be completed. OBJECTIVE This analysis used statewide survey data from Washington State to identify and characterize barriers and facilitators to adoption of WA Verify, and understand how factors such as data privacy, security, attitudes towards public health policies, and technological proficiency may influence acceptance and uptake of digital public health tools. METHODS A statewide survey was distributed from September 2022 through January 2023 to a random sample of 5,000 Washington State households. Respondents were categorized into three groups based on responses that indicated they were WA Verify “users”, “potential users”, or “unlikely users”. Comparisons were made between groups on experiences with and opinions on COVID-19 vaccine and test verification, opinions regarding public health policies and digital tools, technological proficiency, sociodemographic characteristics, and health history. To ensure the analytical sample matched Washington State’s race/ethnicity and age-sex marginal distributions, population weights were created and applied. RESULTS Of the 1,401 respondents, 25.8% (N=359) were users, 49.8% (N=662) were potential users and 24.4% (N=380) were unlikely users. Compared to users and potential users, unlikely users were more likely to oppose policies requiring proof of COVID-19 vaccination and/or negative test results. Unlikely users were more likely to cite personal health data security and phone hacking/tracking concerns, though these were non-trivial among potential users and users. Users and potential users were more likely to agree that protecting their communities was a reason to use a digital vaccine verification system. Unlikely users were more likely to report not owning a smartphone and lower technological proficiency, indicating a technological divide between groups. CONCLUSIONS While nearly three-quarters of respondents either already adopted or were willing to adopt a digital public health tool like WA Verify, data security concerns, technological proficiency, and distrust of public health and its policies were characteristics of individuals least likely to adopt public health tools. Identifying barriers to adoption for those most likely to be “unlikely users” is essential for developing effective communication strategies such as targeted marketing, education, and community engagement to improve adoption and ensure equitable access to public health technologies.