# Privacy and Security in Digital Health Contact-Tracing: A Narrative Review
## 3 Results
### Knowledge and Awareness  
Understanding and awareness of contact-tracing apps play a vital role in whether people use them. Participants often expressed concerns about transparency and insufficient details, leading to doubts about government intentions. Knowledge about contact-tracing apps was positively correlated with app use [46]. A lack of information on the contact-tracing app was reported as one of the reasons for not downloading the contact-tracingapp [70; 104]. Among the students in Italy who did not download contact-tracing apps, 32.7% reported that they believed it was useless, and 23.5% reported that they were not aware they needed to do it [127]. Other reasons, accounting for 18%, included a lack of knowledge about the app [23]. In Canada, the lack of information received about contact-tracing apps was mentioned by 1% of the respondents [27].  
Participants raised key concerns regarding insufficient transparency and a lack of adequate information related to the development and planned implementation of the app. Many felt that the government's intentions were not clear due to a general lack of transparency. Participants stated that the information provided about the app's meaning, nature, and scope was insufficient to convince them of the government's intentions. Additionally, participants believed that government agencies had not taken adequate measures to address people's fears and concerns, given the prevalence of COVID-19-related misinformation online [50].  
Leaders of community-based organisations (CBOs) in certain communities have noticed that there was considerable misinformation about data privacy. Additionally, an advocate for the LGBTQIA+ community pointed out that many people did not fully understand how contact-tracing apps work, which prevents them from enjoying the full benefits of these apps [42]. The lack of publicly available information about how the contact-tracing app works and the associated privacy protections has raised concerns in Australia. The politicians' failure to provide accurate information and address privacy concerns has contributed to the perception of scepticism and mistrust among the public [82].  
In a study conducted in Germany, the results showed a positive correlation between participants' understanding of the app's features and their likelihood of using it [76]. Several issues have been reported regarding the contact-tracing app. These issues include individuals requiring assistance with the app, not receiving initial support, being unaware that the app is available [41], and not knowing how to download it [18]. Poor public communication regarding clarity and outreach has been identified as a challenge [119]. In a study conducted in Indonesia with users of a contact-tracing app, it was found that the purpose of the app, its benefits, and the instructions on utilising its features were not clearly communicated to the users [128]. In line with this, it was reported that understanding the purpose and functionality of the contact-tracing app has significantly increased adoption rates in a cross-country study conducted in European countries and the USA [122].  
Several participants appeared uncertain about the function and scope of contact-tracing apps, sometimes using different technologies [90]. Additionally, a lack of consistent information from the government was identified as a major concern [50]. A lower understanding of government advice was linked to less willingness to download the app [16]. Although the contact-tracing app in Germany meets high standards for data privacy, some people were still hesitant to use it due to their lack of trust in the government and their lack of knowledge about the mechanisms in place for data protection [17].