# Privacy and Security in Digital Health Contact-Tracing: A Narrative Review
## 4 Discussion
### Psychological Factors  
According to the literature, various psychological factors influenced the adoption and use of contact-tracing apps. People often decide to use these apps based on their perceived vulnerability and the severity of the disease [21; 56; 127]. Similarly, people consider using contact-tracing apps to be a social responsibility; they saw controlling the virus as a collective effort [19; 24; 61]. Psychological factors such as emotions, anxiety, and perceptions of the entire contact-tracing process influenced the intention to adopt digital contact-tracing [70], while surveillance led to increased anxiety levels among individuals [17; 97]. It was also reported that some individuals preferred technology over human tracers for their COVID-19 status [115]. However, [PERSON] et al. have reported that salient COVID-19 disease concerns had reduced the intention to download, while most had stated that disease concerns would increase the willingness to use the contact-tracing [21; 56; 100; 118; 127].  
**Recommendations for government.** Governments should frame contact-tracing app adoption as a civic duty and an essential component of collective efforts to combat pandemics. This is because they can appeal to citizens' sense of responsibility and shared vulnerability to create a moral imperative for adoption, addressing psychological motivators like perceived severity and susceptibility. Governments should also minimise surveillance-related anxieties by emphasising that contact-tracing will be temporary and there will be no long-term tracking. This is because alleviating fears of permanent surveillance aligns with citizens' psychological need for autonomy and privacy, thereby reducing barriers to adoption.  
**Recommendations for app developers.** App developers should design the user interface to reduce anxiety, using calming colours, non-intrusive notifications, and reassuring messaging about app security and temporary data use. This is because developers have control over the app's design, which can mitigate psychological barriers such as anxiety and perceptions of surveillance. App developers should also include a feature enabling users to provide feedback or report concerns easily, and visibly address these concerns in updates. This is because giving users a voice and responding to their feedback fosters a sense of control and reduces psychological resistance.  
**Recommendations for an integrated approach.** A national coordination hub for digital contact-tracing should be established. This is necessary, as governments should lead a central hub involving app developers, health services, and privacy experts to standardise development, share resources, and streamline efforts. This ensures consistent goals, avoids redundant work, and integrates technical, legal, and public health expertise to enhance efficiency and app adoption. A unified communication and deployment strategy should also be developed. This is necessary, as governments, app developers, and health services must collaboratively create a consistent strategy for app promotion, privacy assurance, and technical support. This ensures clear, uniform messaging and coordinated rollout, fostering public trust and reducing confusion, which collectively enhance app adoption and usability.  
We acknowledge that this study has few limitations. Only the studies published in English were included in this review, and grey literature was not included. Since retrieving grey literature was a time-consuming task and the review already included a higher number of articles, we did not include grey literature. Further, depending on the topic and the published information we extracted, it was unlikely to significantly alter this study's results by grey literature. In addition, these searches were primarily centred around the privacy and security issues in digital contact-tracing and provide evidence for the role of these issues in the acceptance of contact-tracing apps.