# Privacy and Security in Digital Health Contact-Tracing: A Narrative Review
## 3 Results
### Data Protection and Control
#### 3.2.2 Fear of Surveillance  
Surveillance by authorities influenced people's willingness to use contact-tracing apps [90]. A survey conducted in Germany and Switzerland before and after the introduction of the contact-tracing apps revealed that the use of contact-tracing apps was negatively impacted by a fear of surveillance [36]. People expressed concerns about the potential for governments to establish long-term surveillance systems [90]. The fear of being geo-located was identified as a concern by respondents [27; 100]. They criticised a lack of clarity in communication about how location and movement data were analysed [90]. People strongly disliked the idea of being tracked by the government [101]. According to a study in nine European countries, individuals have expressed their awareness of being monitored through different mediums such as geo-localisation, social media, and web searches; therefore, people felt that using COVID-19 apps could pose a higher threat to their privacy, which was unacceptable [102]. However, in Europe, participants expressed greater comfort with an app that shared location data from tested-positive users instead of sharing location data from all users [79].  
In a Canadian study, among the participants, 46% of participants believed that the contact-tracing app located users through GPS, and 29% expressed a fear that it could identify users [27]. In Singapore, respondents expressed a dislike for location-tracing and believed that their data privacy would be violated by contact-tracing apps [103]. In the UK, the participants who had no intention of downloading the contact-tracing app mentioned that reluctance to be tracked was one of the most prevalent reasons [28; 104]. In another UK study, the most chosen concerns for non-adoption were government surveillance and greater surveillance after the epidemic [97].  
Twitter analysis showed that most discussions on Twitter revolved around contact-tracing and surveillance among health topics [87]. Notably, an Indian study has reported that concerns regarding government surveillance did not significantly impact resistance towards contact-tracing apps, but such concerns indirectly influenced resistance through distrust [57]. Some participants expressed concerns about government tracking and surveillance due to misconceptions about how the apps operate [68].  
In a Malaysian study, the respondents demonstrated a high level of awareness regarding the government's ability to access personal information and location data through the use of a contact-tracing app [105]. Factors such as fear of constant government surveillance influenced negative sentiments about contact-tracing [64; 65]. In a US study, most participants believed that contact-tracing via Bluetooth was appropriate, while using additional location data, such as GPS or Wi-Fi, was perceived as less appropriate [106]. In another US study, the use of Bluetooth technology that does not collect location data and clear privacy policies outlining how personal data are handled seemed to enhance users' trust [52]. A study conducted on young adults showed 45.1% were willing to undergo active monitoring, 33.1% expressed willingness for passive monitoring, including tracking location and contacts through their phones, and 25% remained neutral. Young adults were more willing to share personal health information than location or contact data [107].