The Dutch corona notification app:
lessons learnt from a mixed-method evaluation among end users and contact tracing employees (Preprint)
Authors: van Gend Joris Elmar , van 't Klooster Jan Willem Jaap Roderick , Bolman Catherine Adriana Wilhelmina , van Gemert-Pijnen Julia Elisabeth Wilhelmina Cornelia 
Published: April 2022

BACKGROUND

The Dutch CoronaMelder app is the official Dutch Contact Tracing App (CTA). It is used in the efforts to contain the spread of COVID-19 in the Netherlands. It allows users of apps connected to it to anonymously warn and be warned about potentially high-risk contacts with individuals that have been infected with COVID-19.

OBJECTIVE

The goal of this mixed-method study was to create an understanding of the use of CTA in the global pandemic and its integration in the public health services process of containment of the pandemic through contact tracing. Moreover, the study aimed to investigate both the motivations and user experience related factors for observed behaviour regarding adherence to quarantine and isolation measures, which in turn would affect the use of contact tracing applications.

METHODS

A topic analysis of 56 emails and an online survey amongst 1937 adults from the Netherlands, combined with a series of 48 in-depth interviews with end users of the app and 14 employees of the Dutch Municipal Health Services (MHS) involved in the Contact Tracing process.

RESULTS

The topic analysis and interviews identified issues in the daily use of the CM app both of procedural and technical nature. Procedural issues included the lack of training of Municipal Health Services employees in the use of CTAs. Technical issues for the end users identified include the inability to send notifications without phone contact with the MHS, unwarranted notifications and nightly notifications. Combined, these issues undermined confidence in and satisfaction with the app’s use. The interviews offered a deeper understanding of the various factors at play and their effects on stakeholders, e.g.: a) the mixed experiences of the app’s users (e.g. due to technical issues), the end user’s own fears and uncertainties concerning the Coronavirus; b) problematic infrastructure at the time of the app’s implementation at side of the health services; c) the effects of the society wide efforts in containment of the coronavirus on the CM app’s perception, resulting in further doubts concerning the app’s effectiveness both amongst MHS workers and end users; and d) problems with adherence to behavioural measures propagated by the app as a result of the lack of confidence in the app and uncertainty concerning the execution of the behavioural measures. All findings were evaluated with the app’s creators and have since contributed to improvements.

CONCLUSIONS

Although a majority of participants (n=37) perceived the app positively, both procedural and technical issues limited satisfaction and confidence in the CM app. The study offers lessons learned for future e-health interventions in pandemics applicable both within the Netherlands and internationally that can aid in creating a more consistent and effective implementation and future interventions (apps or other tools). Moreover, the study offers insights into the interaction between large scale communication campaigns, large-scale adoption of an e-health intervention by the general public, and the processes with which that intervention is implemented and operated. Lastly, the study offers a case study of a public health intervention’s evaluation by researchers contributing to improvements.