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BACKGROUND Digital contact tracing (DCT) apps have been recently implemented widely as a response to the Covid-19 pandemic. Research has focused on understanding the acceptance and adoption of these apps, but more work is needed to understand which factors may contribute to sustained use of the app. This is key in public health due to DCT apps needing a high uptake rate to decrease transmission of the virus within the general population. OBJECTIVE To understand changes in use of the NHS Test & Trace (T&T) Covid-19 DCT app and to explore how public trust in the app evolved over a one-year period. METHODS A longitudinal mixed-methods approach was conducted consisting of a digital survey in December 2020 followed by another digital survey and interview in November 2021 in which survey responses from 9 participants were explored in detail. Thematic analysis was used to analyse interview transcripts. This paper focuses on the thematic analysis of the qualitative data to unpack the reasoning behind participants answers to the surveys. RESULTS In this paper, five themes generated through thematic analysis are discussed in detail: flaws of the T&T app; usefulness and functionality affecting trust in the app; low trust in UK government; varying degrees of trust in other stakeholders; and public consciousness and compliance dropping over time. Twenty subthemes were developed within these themes. Mistrust evolved from participants’ experiencing sociotechnical flaws of the T&T app and led to concerns over the app’s usefulness. Likewise, mistrust in the government was linked to perceived poor pandemic handling and creation and procurement of the T&T app, including data management. However, more variability in trust in other stakeholders was highlighted, dependent on perceived competence and intentions. For example, Big Tech companies (i.e. Apple, Google), large hospitality venues, and private contractors were seen as more capable, but participants mistrust their intentions, and small hospitality venues, local councils and NHS (i.e. public health system) were seen as well-intentioned but there is mistrust in their ability to handle pandemic matters. Finally, participants reported complying –or not– with T&T and pandemic guidance to different degrees, but overall observed a drop in compliance over time, both at individual and external levels. CONCLUSIONS The findings of this research contribute to the wider implications of sustained app use for public health. Findings suggest that trust in the wider T&T app ecosystem is needed for sustained use of the app. Initial novelty effects occurred with the T&T app, which lessened over time as public concern and media representation of the pandemic decreased and normalisation occurred. Trust in the sociotechnical capabilities of the app, stakeholders involved, and maintaining salience of the T&T app in conjunction with other measures are needed for sustained use.

BACKGROUND Digital contact tracing is employed to monitor and manage the spread of COVID-19. However, to be effective the system must be adopted by a substantial proportion of the population. Studies of mostly hypothetical contact tracing apps show generally high acceptance, but little is known about the drivers and barriers to adoption of deployed systems. OBJECTIVE The aim of this study was to investigate adoption of and attitudes toward the NHS (National Health Service) COVID-19 smartphone app, the digital contact tracing solution in the United Kingdom. METHODS An online survey based on the extended Technology Acceptance Model with the added factor of trust was carried out with a representative sample of the UK population. Statistical analysis showed adoption rates, attitudes toward and trust in the app, and compliance with self-isolation advice and highlighted differences for vulnerable populations (ie, older adults aged 65 years and over and members of Black, Asian, and minority ethnic [BAME] communities). RESULTS A total of 1001 participants took part in the study. Around half of the participants who had heard of the NHS COVID-19 mobile phone app (490/963, 50.9%; 95% CI 47.8%-54.0%) had downloaded and kept the app, but more than one-third (345/963, 35.8%; 95% CI 32.8%-38.8%) either did not intend to download it or had deleted it. Significantly more BAME respondents than White respondents had deleted the app (16/115, 13.9%; 95% CI 11.8%-16.0%, vs 65/876, 7.4%; 95% CI 5.8%-9.0%), and significantly more older adults 65 years and over than those under 65 years did not intend to download it (44/127, 34.6%; 95% CI 31.7%-37.5%, vs 220/874, 25.2%; 95% CI 22.5%-27.9%). Broadly, one of the reasons for uptake was to help the NHS and other people, especially among older adults, although significantly fewer BAME participants agreed that they did so to help the NHS. Reported compliance with received notifications to self-isolate was high but was significantly lower than reported intended compliance without received notifications. Only one-fifth (136/699, 19.5%; 95% CI 17.0%-22.0%) of participants understood that the decision to send self-isolation notifications was automated by the app. There were a range of significantly more negative views among BAME participants, including lower trust in the NHS, while older adults were often significantly more positive. Respondents without the app reported significantly lower trust and more negative views toward the app and were less likely to report that they understood how the app works. CONCLUSIONS While compliance on the part of the approximately 50% of participants who had the app was fairly high, there were issues surrounding trust and understanding that hindered adoption and, therefore, the effectiveness of digital contact tracing, particularly among BAME communities. This study highlights that more needs to be done to improve adoption among groups who are more vulnerable to the effects of the virus in order to enhance uptake and acceptance of contact tracing apps.

BACKGROUND Algorithms rule the online environments and are essential for performing data processing, filtering, personalisation and other tasks. Research has shown that children and young people make up a significant proportion of Internet users, however little attention has been given to their experiences of algorithmically-mediated online platforms, or the impact of them on their mental health and well-being. The algorithms that govern online platforms are often obfuscated by a lack of transparency in their online Terms and Conditions and user agreements. This lack of transparency speaks to the need for protecting the most vulnerable users from potential online harms. OBJECTIVE To capture young people's experiences when being online and perceived impact on their well-being. METHODS In this paper, we draw on qualitative and quantitative data from a total of 260 children and young people who took part in a ‘Youth Jury’ to bring their opinions to the forefront, elicit discussion of their experiences of using online platforms, and perceived psychosocial impact on users. RESULTS The results of the study revealed the young people’s positive as well as negative experiences of using online platforms. Benefits such as being convenient and providing entertainment and personalised search results were identified. However, the data also reveals participants’ concerns for their privacy, safety and trust when online, which can have a significant impact on their well-being. CONCLUSIONS We conclude by making recommendations that online platforms acknowledge and enact on their responsibility to protect the privacy of their young users, recognising the significant developmental milestones that this group experience during these early years, and the impact that technology may have on them. We argue that governments need to incorporate policies that require technologists and others to embed the safeguarding of users’ well-being within the core of the design of Internet products and services to improve the user experiences and psychological well-being of all, but especially those of children and young people. CLINICALTRIAL N/A