JMIR Publications

ABSTRACT

Background:

The silent transmission of COVID-19 has led to an exponential growth of fatal infections. With over 3 million deaths world-wide, the need to control and stem transmission has never been more critical. New COVID-19 vaccines offer hope. However, administration timelines, long-term protection, and effectiveness against variants are still unknown. In this context, Contact Tracing, and digital Contact Tracing Apps (CTAs) continue to offer a mechanism to help contain transmission, keep people safe, and help kickstart economies. However, CTAs must address a wide range of often conflicting concerns which make their development/evolution complex: for example, the app must preserve citizens’ privacy whilst gleaning their close contacts and as much epidemiological information as possible.

Objective:

In this paper, we derive a compare-and-contrast evaluative framework for CTAs that captures best-of-breed development and evolution concerns for CTAs organized into seven pillars. As our goal is to integrate and expand on existing work in this domain, with a particular focus on citizen adoption, we call this framework the Citizen-Focused Compare-and-Contrast Evaluation Framework (C3EF) for CTAs.

Methods:

The framework has been derived through mixed methods. First, we reviewed the related literature on CTAs and mHealth app evaluations, from which we derived a preliminary set of attributes and organizing pillars. These attributes were validated, augmented, and refined by applying the provisional framework against a selection of CTAs. At this point, questions to probe each attribute of the framework were formulated and iteratively tested on selected CTAs. Each framework pillar was then subjected to internal cross-team scrutiny where domain experts responsible for developing a pillar defended its sufficiency, relevancy, specificity, and non-redundancy. The consolidated framework was further validated on the selected CTAs to create a refined version of C3EF for CTAs.

Results:

The final framework presents seven pillars exploring issues related to CTA’s design, adoption, and use: (General) Characteristics, Usability, Data Protection, Effectiveness, Transparency, Technical Performance, and Citizen Autonomy. The pillars encompass attributes, sub-attributes, and a set of illustrative questions (with associated example answers) to support app design, evaluation, and evolution. An online version of the framework has been made available to developers, health authorities, and others interested in assessing CTAs.

Conclusions:

Our CTA evaluation-concerns framework provides a holistic compare-and-contrast tool that supports the work of decision-makers in the development and evolution of CTAs for citizens. This framework supports reflection on design decisions to better understand and optimize the design compromises in play when evolving current CTAs for increased public adoption. We intend it to act as a foundation for other researchers to build on and extend, as the technology matures and new CTAs become available.