Understanding Trust and Changes in Use After a Year With the NHS COVID-19 Contact Tracing App in the United Kingdom: Longitudinal Mixed Methods Study

Abstract

Background Digital contact tracing (DCT) apps have been implemented as a response to the COVID-19 pandemic. Research has focused on understanding acceptance and adoption of these apps, but more work is needed to understand the factors that may contribute to their sustained use. This is key to public health because DCT apps require a high uptake rate to decrease the transmission of the virus within the general population. Objective This study aimed to understand changes in the use of the National Health Service Test & Trace (T&T) COVID-19 DCT app and explore how public trust in the app evolved over a 1-year period. Methods We conducted a longitudinal mixed methods study consisting of a digital survey in December 2020 followed by another digital survey and interview in November 2021, in which responses from 9 participants were explored in detail. Thematic analysis was used to analyze the interview transcripts. This paper focuses on the thematic analysis to unpack the reasoning behind participants’ answers. Results In this paper, 5 themes generated through thematic analysis are discussed: flaws in the T&T app, usefulness and functionality affecting trust in the app, low trust in the UK government, varying degrees of trust in other stakeholders, and public consciousness and compliance dropping over time. Mistrust evolved from participants experiencing sociotechnical flaws in the app and led to concerns about the app’s usefulness. Similarly, mistrust in the government was linked to perceived poor pandemic handling and the creation and procurement of the app. However, more variability in trust in other stakeholders was highlighted depending on perceived competence and intentions. For example, Big Tech companies (ie, Apple and Google), large hospitality venues, and private contractors were seen as more capable, but participants mistrust their intentions, and small hospitality venues, local councils, and the National Health Service (ie, public health system) were seen as well-intentioned but there is mistrust in their ability to handle pandemic matters. Participants reported complying, or not, with T&T and pandemic guidance to different degrees but, overall, observed a drop in compliance over time. Conclusions These findings contribute to the wider implications of changes in DCT app use over time for public health. Findings suggest that trust in the wider T&T app ecosystem could be linked to changes in the use of the app; however, further empirical and theoretical work needs to be done to generalize the results because of the small, homogeneous sample. Initial novelty effects occurred with the app, which lessened over time as public concern and media representation of the pandemic decreased and normalization occurred. Trust in the sociotechnical capabilities of the app, stakeholders involved, and salience maintenance of the T&T app in conjunction with other measures are needed for sustained use.

Exploring individual's public trust in the NHS Test and Trace System – A pragmatic reflexive thematic analysis

“…Social media has been held responsible for mass sharing of misinformation during the pandemic, which can result in people not adhering to public health recommendations ( Laato et al, 2020 ). A longitudinal study repeating the survey deployed by this research group explored the perception and use of the app over time and identified the media as being influential in creating mistrust and negative perceptions of the COVID-19 app ( Pepper et al, 2022 ). The mass misinformation from the pandemic has highlighted the challenge for the digital medical landscape, where patients may feel greater trust in news or social media than in public health systems ( Pennycook et al, 2020 ).…”

“…The mass misinformation from the pandemic has highlighted the challenge for the digital medical landscape, where patients may feel greater trust in news or social media than in public health systems ( Pennycook et al, 2020 ). Increased distrust in the government may have reduced compliance with healthcare recommendations during COVID-19 ( Bollyky et al, 2022 ) and was reported as the largest contributor to diminishing use of the app in a longitudinal study exploring use of the app and trust over time ( Pepper et al, 2022 ). Furthermore, the elderly were the most likely to believe misinformation relating to COVID-19 ( Bapaye and Bapaye, 2021 ), and BAME groups had lower trust in the NHS and the government and were less likely to download the app to support the NHS ( Dowthwaite et al, 2021b ).…”

Perceptions of the Agency and Responsibility of the NHS COVID-19 App on Twitter: Critical Discourse Analysis

“…A follow-up analysis showed that there were statistically significant correlations between lower trust among nonusers, many aspects of the app, and the wider social and societal context [46]. A year after the app was launched, Pepper et al [2] identified 5 main themes during follow-up interview discussions: flaws in the app, usefulness and functionality affecting trust in the app, low trust in the UK government, varying degrees of trust in other stakeholders, and public disinterest. According to the study results, these factors contributed to a drop in compliance over time.…”

“…The agency of automated decision-making algorithms is a long-standing debate in academic research [1][2][3]. Decision-making algorithms can mitigate human errors or inaccuracies [4][5][6][7].…”

mHealth and COVID-19: A Bibliometric Study

“…As time passes, many countries prepare for an endemic stage of the COVID-19 pandemic [ 11 , 12 ]. Some mHealth apps, such as contact-tracing apps, may no longer be necessary because many countries and people have disabled such apps since late 2021 [ 13 , 14 ].…”