London School of Hygiene & Tropical Medicine

Regional differences in uptake of the NHS Covid-19 app were related to the extent to which people believed that the app was relevant to their everyday life.

A representative online survey of 1,067 smartphone users between October 2020 and September 2021 showed uptake of the app in Wales was consistently below 50%, significantly lower than in all of England, with uptake in the North of England the lowest of the English regions.

The study, by a team from the London School of Hygiene & Tropical Medicine (LSHTM), found that by September of 2021 only 35% of respondents in Wales said they had the app installed as opposed to 48% of respondents in Northern England and 52% in London and South England.

The research, published in the journal Digital Health, could offer important lessons for designing apps for future pandemics.

The team suggest that the perceived utility of the app in different regions could have been at the heart of people’s decisions to download or delete it. While “civic, public or social responsibility” was the reason most respondents gave for installing the app at launch, needing “to scan NHS QR code” became a major reason to download it later on.

The researchers point out that in Wales it was never mandatory for venues to display QR codes while Northern England was placed in higher tiers of restrictions than the rest of the country for longer so this kind of functionality may not have seemed useful.

Despite evidence before the app’s launch that 62% of the British public would be willing to download it, installations among respondents never reached this level. This may have been the result of technical issues soon after launch and the so-called ‘Pingdemic’ in summer 2021 when there were claims the app was sending false alerts – a narrative never effectively countered despite the arrival of the highly infectious Delta strain – damaging confidence in the app’s usefulness, the researchers say.

Mustafa Al-Haboubi, Assistant Professor at LSHTM and lead author of the study, said: “Our results suggest that while people may cite altruistic reasons for downloading a pandemic app in the first place “to help stop the spread of Coronavirus and return to normal”, ultimately, if it isn’t seen as useful to them in their everyday lives, many will uninstall it. Those designing apps for future pandemics need to take into account this ‘use it or lose it’ mentality, ensuring that they maximise the incentives for individuals to continue using an app that has benefits for wider society.”

The study also looked at uptake of the app among 321 people belonging to six major ethnic minority groups between October 2020 and September 2021. Despite COVID-19’s disproportionate impact on ethnic minority groups uptake was significantly lower than in the general population of smartphone users. Respondents identifying as Pakistani were least likely to download the app at any time, with uptake of only 33% at launch dipping to a low of 22% in March 2021. Only the group identifying as Indian reached over 50% at any time.

The researchers suggest one reason for the disparity in installations is that members of ethnic minorities have generally been shown to have lower trust in government. Future app designers should take into account differences between ethnic minority groups in attitudes to such apps and the information they generate. There is unlikely to be a ‘one size fits all’ solution to improving uptake.

Publication

Al-Haboubi et al, “One year of digital contact tracing: Who was more likely to install the NHS COVID-19 app? Results from a tracker survey in England and Wales”, Digital Health, DOI: 10.1177/20552076231159449