scholarly journals Analysis of the factors affecting the adoption and compliance of the NHS COVID-19 mobile application: a national cross-sectional survey in England

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e053395
Author(s):  
Marcus Panchal ◽  
Sukhpreet Singh ◽  
Esther Rodriguez-Villegas
Keyword(s):  
Independent Study ◽  
Contact Tracing ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Privacy And Security ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Factors Affecting ◽  
Privacy Concerns ◽  
The Uk

ObjectivesTo conduct an independent study investigating how adults perceive the usability and functionality of the ‘National Health Service (NHS) COVID-19’ application (app). This study aims to highlight strengths and provide recommendations to improve adoption of future contact tracing developments.DesignA 60-item, anonymous online questionnaire, disseminated through social media outlets and email lists by a team from Imperial College London.SettingEngland.ParticipantsConvenience sample of 1036 responses, from participants aged 18 years and above, between December 2020 and January 2021.Primary outcome measuresEvaluate the compliance and public attitude towards the ‘NHS COVID-19’ app regarding its functionality and features. This included whether participants’ expectations were met, and their thoughts on the app privacy and security. Furthermore, to distinguish how usability, perception, and adoption differed with varying demographics and user values.ResultsFair compliance with the app features was identified, meeting expectations of the 62.1% of participants who stated they downloaded it after weighted analysis. However, participants finding the interface challenging were less likely to read information in the app and had a lesser understanding of its functionality. Furthermore, little understanding regarding the app’s functionality and privacy concerns was a possible reason why users did not download it. A readability analysis of the text revealed information within the app was conveyed at a level that may be too complex for up to 43% of the UK population. The study highlighted issues related to the potential of false positives caused by the design choices in the ‘Check-In’ feature.ConclusionThis study showed that while the ‘NHS COVID-19’ app was viewed positively, there remained issues regarding participants’ perceived knowledge of app functionality, potentially affecting compliance. Therefore, we recommended improvements regarding the delivery and presentation of the app’s information, and highlighted the potential need for the ability to check out of venues to reduce the number of false positive contacts.

scholarly journals Barriers and enablers of implementation of alcohol guidelines with pregnant women: a cross-sectional survey among UK midwives

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lesley A. Smith ◽  
Judith Dyson ◽  
Julie Watson ◽  
Lisa Schölin
Keyword(s):  
Theoretical Domains Framework ◽  
Professional Role ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Professional Networks ◽  
Convenience Sample ◽  
Improved Outcomes ◽  
The Uk ◽  
Alcohol Assessment

Abstract Background In 2016, the UK Chief Medical Officers revised their guidance on alcohol and advised women to abstain from alcohol if pregnant or planning pregnancy. Midwives have a key role in advising women about alcohol during pregnancy. The aim of this study was to investigate UK midwives’ practices regarding the 2016 Chief Medical Officers Alcohol Guidelines for pregnancy, and factors influencing their implementation during antenatal appointments. Methods Online cross-sectional survey of a convenience sample of UK midwives recruited through professional networks and social media. Data were gathered using an anonymous online questionnaire addressing knowledge of the 2016 Alcohol Guidelines for pregnancy; practice behaviours regarding alcohol assessment and advice; and questions based on the Theoretical Domains Framework (TDF) to evaluate implementation of advising abstinence at antenatal booking and subsequent antenatal appointments. Results Of 842 questionnaire respondents, 58% were aware of the 2016 Alcohol Guidelines of whom 91% (438) cited abstinence was recommended, although 19% (93) cited recommendations from previous guidelines. Nonetheless, 97% of 842 midwives always or usually advised women to abstain from alcohol at the booking appointment, and 38% at subsequent antenatal appointments. Mean TDF domain scores (range 1–7) for advising abstinence at subsequent appointments were highest (indicative of barriers) for social influences (3.65 sd 0.84), beliefs about consequences (3.16 sd 1.13) and beliefs about capabilities (3.03 sd 073); and lowest (indicative of facilitators) for knowledge (1.35 sd 0.73) and professional role and identity (1.46 sd 0.77). Logistic regression analysis indicated that the TDF domains: beliefs about capabilities (OR = 0.71, 95% CI: 0.57, 0.88), emotion (OR = 0.78; 95%CI: 0.67, 0.90), and professional role and identity (OR = 0.69, 95%CI 0.51, 0.95) were strong predictors of midwives advising all women to abstain from alcohol at appointments other than at booking. Conclusions Our results suggest that skill development and reinforcement of support from colleagues and the wider maternity system could support midwives’ implementation of alcohol advice at each antenatal appointment, not just at booking could lead to improved outcomes for women and infants. Implementation of alcohol care pathways in maternity settings are beneficial from a lifecourse perspective for women, children, families, and the wider community.

scholarly journals GP retention in the UK: a worsening crisis. Findings from a cross-sectional survey

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e026048 ◽  
Author(s):  
Katherine Owen ◽  
Thomas Hopkins ◽  
Thomas Shortland ◽  
Jeremy Dale
Keyword(s):  
National Policy ◽  
Intention To Leave ◽  
Work Intensity ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Length Of Service ◽  
Cross Sectional ◽  
Career Intention ◽  
National Initiatives ◽  
The Uk

ObjectiveTo investigate how recent national policy-led workforce interventions are affecting intentions to remain working as a general practitioner (GP).DesignOnline questionnaire survey with qualitative and quantitative questions.Setting and participantsAll GPs (1697) in Wessex region, an area in England for which previous GP career intention data from 2014 is available.Results929 (54.7%) participated. 59.4% reported that morale had reduced over the past two years, and 48.5% said they had brought forward their plans to leave general practice. Intention to leave/retire in the next 2 years increased from 13% in the 2014 survey to 18% in October/November 2017 (p=0.02), while intention to continue working for at least the next 5 years dropped from 63.9% to 48.5% (p<0.0001). Age, length of service and lower job satisfaction were associated with intention to leave. Work intensity and amount were the most common reasons given for intention to leave sooner than previously planned; 51.0% participants reported working more hours than 2 years previously, predominantly due to increased workload.GPs suggested increased funding, more GPs, better education of the public and expanding non-clinical and support staff as interventions to improve GP retention.National initiatives that aligned with these priorities, such as funding to expand practice nursing were viewed positively, but low numbers of GPs had seen evidence of their roll-out. Conversely, national initiatives that did not align, such as video consulting, were viewed negatively.ConclusionWhile recent initiatives may be having an impact on targeted areas, most GPs are experiencing little effect. This may be contributing to further lowering of morale and bringing forward intentions to leave. More urgent action appears to be needed to stem the growing workforce crisis.

scholarly journals Acceptability of a COVID-19 Vaccine Among Healthcare Workers in the Kingdom of Saudi Arabia

2021 ◽  
Vol 8 ◽  
Author(s):  
Ameerah M. N. Qattan ◽  
Noor Alshareef ◽  
Omar Alsharqi ◽  
Naseem Al Rahahleh ◽  
Gowokani Chijere Chirwa ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Healthcare Workers ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Chi Squared ◽  
Health Related

Objective: This study aims to determine the acceptability of a COVID-19 vaccine among healthcare workers in Saudi Arabia and the factors affecting their intention to accept the vaccine.Methods: The study used data from an online cross-sectional survey that was conducted in Saudi Arabia between 8 December 2020 and 14 December 2020. This study employed bivariate and multivariable regression analyses. The bivariate was used to describe and tabulate the frequency of all the variables, including the sociodemographic characteristics, the risk perception and the acceptance of the COVID-19 vaccination and a chi-squared test of independence was calculated. Multivariable logistic regression models were employed to examine and identify the factors associated with an intention to have the COVID-19 vaccination and the factors associated with its immediate acceptance.Results: Of the total of 736 healthcare workers who began the online questionnaire, 673 completed it (a 91.44% completion rate). Among the study participants, 50.52% were willing to have the COVID-19 vaccine, of which 49.71% intended to have the vaccine as soon as it becomes available in the country, while 50.29% would delay until the vaccine's safety is confirmed. Being a male healthcare worker, perceiving a high risk of infection, and believing that the COVID-19 vaccine should be compulsory for all citizens and residents in the country increased the probability of intention to vaccinate against COVID-19 and the probability of accepting the COVID-19 vaccination as soon as possible.Conclusion: This study calls for more health-related education among healthcare workers to alleviate any fears that might be associated with the COVID-19 vaccine.

scholarly journals THE RELATIONSHIP BETWEEN AGE GROUPS AND KNOWLEDGE AND UNDERSTANDING OF COVID-19 VACCINE

2021 ◽  
Vol 9 (08) ◽  
pp. 482-48/6
Author(s):  
Laphatrada Sakunee ◽  
◽  
Nakamon Khorprasert ◽  
Nitit Noumtong ◽  
Tanyaporn Tangguay ◽  
...  
Keyword(s):  
Consumption Rate ◽  
Age Groups ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Vaccine Candidates ◽  
The Third ◽  
Preventative Measures ◽  
The Relationship

Coronavirus disease 2019 (COVID-19) is still an ongoing issue in the New Normal world. As COVID-19 is a human-to-human transmission disease, the viruses spread widely, and many people got infected. There are several preventative measures used to protect an individual from this situation, including vaccination. Thus, more vaccine candidates have been provided to generate a specific immune response against the disease-causing agent, and are prepared. Additionally, not all vaccine candidates are suitable for each individual. The main purposes of this study were to evaluate and determine the knowledge and understanding of the COVID-19 vaccines and the relationship between age groups and Thai citizens. To test whether the two aforementioned variables correlate, we conducted a cross-sectional survey through an online platform, Google form. Four hundred and Ten participants completed the survey. To determine the correlation, we used Statistical Product and Service Solution version 22.0 (SPSS) for data analysis. Pearsons correlation test revealed that there is no significant correlation between age groups and knowledge and understanding of COVID-19 vaccines. Although we did not find any correlation, we think that there may be other factors affecting peoples knowledge about the COVID-19 vaccines such as the sudden awareness due to the new pandemic outbreak and the straightforwardness of our online questionnaire. Since most people are now facing the third ripple of COVID-19 crisis, there might be a higher consumption rate of COVID-19 vaccine news and the majority of seniors (aged above 60) tend to reject answering the online questionnaire which significantly reduced our sample size.

scholarly journals Factors associated with adherence to self-isolation and lockdown measures in the UK; a cross-sectional survey

2020 ◽  
Author(s):  
Louise E. Smith ◽  
Richard Amlôt ◽  
Helen Lambert ◽  
Isabel Oliver ◽  
Charlotte Robin ◽  
...  
Keyword(s):  
High Temperature ◽  
Contact Tracing ◽  
List Type ◽  
Perceived Effectiveness ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Perceived Severity ◽  
Factors Associated ◽  
Preventative Measures ◽  
The Uk

AbstractObjectivesTo investigate factors associated with adherence to self-isolation and lockdown measures due to COVID-19 in the UK.DesignOnline cross-sectional survey.SettingData were collected between 6th and 7th May 2020.Participants2240 participants living in the UK aged 18 years or over. Participants were recruited from YouGov’s online research panel.Main outcome measuresHaving gone out in the last 24 hours in those who reported symptoms of COVID-19 in their household. Having gone out shopping for items other than groceries, toiletries or medicines (non-essentials), and total number of outings, in the last week in those who reported no symptoms of COVID-19 in their household.Results217 people (9.7%) reported that they or someone in their household had symptoms of COVID-19 (cough or high temperature / fever) in the last seven days. Of these people, 75.1% had left the home in the last 24 hours (defined as non-adherent). Factors associated with non-adherence were being male, less worried about COVID-19, and perceiving a smaller risk of catching COVID-19. Adherence was associated with having received help from someone outside your household. Results should be taken with caution as there was no evidence for associations when controlling for multiple analyses. Of people reporting no symptoms in the household, 24.5% had gone out shopping for non-essentials in the last week (defined as non-adherent). Factors associated with non-adherence and with a higher total number of outings in the last week included decreased perceived effectiveness of Government “lockdown” measures, decreased perceived severity of COVID-19, and decreased estimates of how many other people were following lockdown rules. Having received help was associated with better adherence.ConclusionsAdherence to self-isolation is poor. As we move into a new phase of contact tracing and self-isolation, it is essential that adherence is improved. Communications should aim to increase knowledge about actions to take when symptomatic or if you have been in contact with a possible COVID-19 case. They should also emphasise the risk of catching and spreading COVID-19 when out and about and the effectiveness of preventative measures. Using volunteer networks effectively to support people in isolation may promote adherence.WHAT IS ALREADY KNOWN ON THIS TOPICThe UK Government introduced “lockdown” measures, including physical or ‘social’ distancing, on 23rd March 2020 due to COVID-19.Government guidance states that people with symptoms of COVID-19 should not leave their home, also known as self-isolation.There is no research investigating adherence to self-isolation and lockdown measures, or factors associated with self-isolation or lockdown measures in the UK.WHAT THIS STUDY ADDSApproximately 10% of participants indicated that they had had symptoms of potential COVID-19 (cough and high temperature / fever) in the last week. Of these participants, 75% had left their home in the last 24 hours.Factors associated with non-adherence to self-isolation measures included being male, less worried about COVID-19, and perceiving a smaller risk of catching COVID-19. However, these results should be taken with caution as there was no longer evidence for associations when correcting for multiple analyses.25% of people who reported no symptoms in their household reported having gone out shopping for items other than groceries, toiletries or medicines in the last week; this was not allowed by Government guidelines in place at the time of data collection.Factors associated with non-adherence to lockdown measures, and increased number of outings in the last week, included decreased perceived effectiveness of Government “lockdown” measures, decreased perceived severity of COVID-19, and decreased estimates of how many other people were following lockdown rules.

scholarly journals Analysis of the Factors Affecting the Adoption and Compliance of the NHS COVID-19 Mobile Application

2021 ◽  
Author(s):  
Marcus Panchal ◽  
Sukhpreet Singh ◽  
Esther Rodriguez-Villegas
Keyword(s):  
Social Media ◽  
Independent Study ◽  
Contact Tracing ◽  
List Type ◽  
Privacy And Security ◽  
Web Based ◽  
Factors Affecting ◽  
Mailing Lists ◽  
Perceived Usability ◽  
Media Channels

AbstractObjectivesTo conduct an independent study investigating how adults perceive the usability, and functionality of the “NHS COVID-19” app. This study aims to highlight strengths, and provide recommendations to improve adoption of future contact tracing developments.Design, Setting, and Participants1036 adults in England and Wales completed a 60-item, web-based observational survey. This survey was disseminated through social media outlets and email-lists.Primary Outcome MeasuresTo evaluate the compliance and public attitude towards the “NHS COVID-19” app, regarding its functionality and main features. This included whether participants expectations were met, and their thoughts on the privacy and security of app data. Furthermore, to distinguish how usability, perception, and adoption differed with varying demographics and user values.ResultsFair rates of app compliance were identified across participants, with the app meeting the expectation of 59.7% of participants who downloaded it. However, participants finding the interface challenging were less likely to read information in the app and had a lesser understanding of its functionality. Furthermore, lack of understanding regarding the app’s functionality and privacy preserving features were behind the reasons why users did not download it. A readability analysis of the text revealed that the information of the app was conveyed at a level which might only be accessible to under 60% of the population. The study highlighted issues related to the high probability of false positives caused by the design choices in the “Check-In” feature.ConclusionThis study showed that while the “NHS COVID-19” app was viewed positively, however, there remained issues regarding participants perceived knowledge of the app with privacy and functionality, which appeared to affect compliance. Therefore, we have recommended improvements regarding the delivery and presentation of the app’s information, and highlighted the potential need for the ability to check out of venues to reduce the number of false positive contacts.Strengths and LimitationsThis is the first study assessing the perceived usability and functionality of the “NHS COVID-19” app directly from app users.Diverse sample size, with representation from all major regions of England.Statistical analysis to compare perceived app usability and functionality across demographics and the participants values regarding privacy and information.Study was conducted during lockdown where app use may have been minimal.Study may have missed potential participants who were not active on the relevant social media channels and email mailing lists which were used to disseminate the survey.

scholarly journals Antimicrobial Stewardship Programmes in Saudi Hospitals: Evidence from a National Survey

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 193 ◽  
Author(s):  
Saleh Alghamdi ◽  
Ilhem Berrou ◽  
Zoe Aslanpour ◽  
Alaa Mutlaq ◽  
Abdul Haseeb ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Treatment Success ◽  
National Level ◽  
Success Rates ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Healthcare Facilities

Saudi hospitals and healthcare facilities are facing increasing rates of antimicrobial resistance and the emergence of new multi-drug resistant strains. This is placing an unprecedented threat to successful treatments and outcomes of patients accessing those facilities. The inappropriate use of antimicrobials is fueling this crisis, warranting urgent implementation of interventions to preserve antimicrobials and reduce resistance rates. Antimicrobial stewardship programmes (ASPs) can improve antimicrobial use, treatment success rates and reduce the levels of antimicrobial resistance. The Saudi Ministry of Health (MOH) devised a national antimicrobial stewardship plan to implement ASPs in hospitals, but little is known about the progress of implementation and the factors affecting it. This study aims to assess the level and the factors affecting the adoption and implementation of ASPs in Saudi hospitals at a national level. A nationwide cross-sectional survey was conducted in 2017 using an online questionnaire sent to all MOH hospitals. Overall, 147 out 247 MOH hospitals responded to the survey (54%). Only 26% of the hospitals reported the implementation of ASPs. Hospitals lack the knowledge, technological and staff resources to adopt and implement ASPs. Alternative models of ASP adoption could be explored to improve the rates of implementation of ASPs.

scholarly journals A pilot survey of socio-economic differences in child-feeding behaviours among parents of primary-school children

2008 ◽  
Vol 11 (10) ◽  
pp. 1030-1036 ◽  
Author(s):  
Heather R Clark ◽  
Elizabeth Goyder ◽  
Paul Bissell ◽  
Lindsay Blank ◽  
Stephen J Walters ◽  
...  
Keyword(s):  
Primary Schools ◽  
Overweight And Obesity ◽  
Primary School Children ◽  
Cross Sectional Survey ◽  
Child Feeding ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Parent Status ◽  
The Uk ◽  
Feeding Behaviours

AbstractObjectiveParents’ child-feeding behaviours have been implicated in children’s food choices and weight, but little is known about the social class distribution of parent’s child-feeding behaviours in the UK. The present study compares parents’ self-reported child-feeding behaviours in two socio-economically contrasting areas.DesignA cross-sectional survey using the Parental Feeding Style Questionnaire. Mean scores were calculated for five child-feeding behaviours: control over eating, emotional feeding, encouragement/prompting, instrumental feeding and restriction. Parents’ self-reported child-feeding behaviours were compared with their sociodemographic characteristics.SettingThree primary schools in two contrasting electoral wards of Sheffield, UK.SubjectsTwo hundred and ten parents of children aged 4 to 11 years, recruited from a convenience sample.ResultsParents in the least deprived ward reported using all five types of child-feeding behaviour more frequently than parents in the most deprived ward. After adjusting for parent sex, parent age, single parent status, employment status and level of education, emotional feeding was the only behaviour showing any evidence of a difference between wards. The most frequently used behaviours were control, encouragement and restriction – behaviours that might be used to directly influence children’s food intake and weight.ConclusionsChild-feeding behaviours differ between areas within a single city and within a largely white population, and this distribution is related to socio-economic and educational factors. Experimental and longitudinal studies are needed to further investigate the potential role of child-feeding behaviours in childhood overweight and obesity.

scholarly journals Patients’ Perspectives About Factors Affecting Their Use of Electronic Personal Health Records in England: Qualitative Analysis (Preprint)

2019 ◽  
Author(s):  
Alaa Abd-Alrazaq ◽  
Zeineb Safi ◽  
Bridgette M Bewick ◽  
Mowafa Househ ◽  
Peter H Gardner
Keyword(s):  
Quantitative Data ◽  
Qualitative Data ◽  
Personal Health Record ◽  
Personal Contact ◽  
Personal Health ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Factors Affecting ◽  
System P

BACKGROUND General practices (GPs) in England have recently introduced a nationwide electronic personal health record (ePHR) system called Patient Online or GP online services, which allows patients to view parts of their medical records, book appointments, and request prescription refills. Although this system is free of charge, its adoption rates are low. To improve patients’ adoption and implementation success of the system, it is important to understand the factors affecting their use of the system. OBJECTIVE The aim of this study is to explore patients’ perspectives of factors affecting their use of ePHRs in England. METHODS A cross-sectional survey was carried out between August 21 and September 26, 2017. A questionnaire was used in this survey to collect mainly quantitative data through closed-ended questions in addition to qualitative data through an open-ended question. A convenience sample was recruited in 4 GPs in West Yorkshire, England. Given that the quantitative data were analyzed in a previous study, we analyzed the qualitative data using thematic analysis. RESULTS Of the 800 eligible patients invited to participate in the survey, 624 (78.0%) returned a fully completed questionnaire. Of those returned questionnaires, the open-ended question was answered by 136/624 (21.8%) participants. A total of 2 meta-themes emerged from participants’ responses. The first meta-theme comprises 5 themes about why patients do not use Patient Online: concerns about using Patient Online, lack of awareness of Patient Online, challenges regarding internet and computers, perceived characteristics of nonusers, and preference for personal contact. The second meta-theme contains 1 theme about why patients use Patient Online: encouraging features of Patient Online. CONCLUSIONS The challenges and concerns that impede the use of Patient Online seem to be of greater importance than the facilitators that encourage its use. There are practical considerations that, if incorporated into the system, are likely to improve its adoption rate: Patient Online should be useful, easy to use, secure, and easy to access. Different channels should be used to increase the awareness of the system, and GPs should ease registration with the system and provide manuals, training sessions, and technical support. More research is needed to assess the effect of the new factors found in this study (eg, lack of trust, difficulty registering with Patient Online) and factors affecting the continuing use of the system.

scholarly journals Reasons for Nonuse, Discontinuation of Use, and Acceptance of Additional Functionalities of a COVID-19 Contact Tracing App: Cross-sectional Survey Study (Preprint)

2021 ◽  
Author(s):  
Michel Walrave ◽  
Cato Waeterloos ◽  
Koen Ponnet
Keyword(s):  
Online Survey ◽  
Critical Mass ◽  
Survey Study ◽  
Contact Tracing ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Privacy Concerns ◽  
Sociodemographic Differences ◽  
Potential Impact ◽  
And Control

BACKGROUND In several countries, contact tracing apps (CTAs) have been introduced to warn users if they have had high-risk contacts that could expose them to SARS-CoV-2 and could, therefore, develop COVID-19 or further transmit the virus. For CTAs to be effective, a sufficient critical mass of users is needed. Until now, adoption of these apps in several countries has been limited, resulting in questions on which factors prevent app uptake or stimulate discontinuation of app use. OBJECTIVE The aim of this study was to investigate individuals’ reasons for not using, or stopping use of, a CTA, in particular, the Coronalert app. Users’ and nonusers’ attitudes toward the app’s potential impact was assessed in Belgium. To further stimulate interest and potential use of a CTA, the study also investigated the population’s interest in new functionalities. METHODS An online survey was administered in Belgium to a sample of 1850 respondents aged 18 to 64 years. Data were collected between October 30 and November 2, 2020. Sociodemographic differences were assessed between users and nonusers. We analyzed both groups’ attitudes toward the potential impact of CTAs and their acceptance of new app functionalities. RESULTS Our data showed that 64.9% (1201/1850) of our respondents were nonusers of the CTA under study; this included individuals who did not install the app, those who downloaded but did not activate the app, and those who uninstalled the app. While we did not find any sociodemographic differences between users and nonusers, attitudes toward the app and its functionalities seemed to differ. The main reasons for not downloading and using the app were a perceived lack of advantages (308/991, 31.1%), worries about privacy (290/991, 29.3%), and, to a lesser extent, not having a smartphone (183/991, 18.5%). Users of the CTA agreed more with the potential of such apps to mitigate the consequences of the pandemic. Overall, nonusers found the possibility of extending the CTA with future functionalities to be less acceptable than users. However, among users, acceptability also tended to differ. Among users, functionalities relating to access and control, such as digital certificates or “green cards” for events, were less accepted (358/649, 55.2%) than functionalities focusing on informing citizens about the spread of the virus (453/649, 69.8%) or making an appointment to get tested (525/649, 80.9%). CONCLUSIONS Our results show that app users were more convinced of the CTA’s utility and more inclined to accept new app features than nonusers. Moreover, nonusers had more CTA-related privacy concerns. Therefore, to further stimulate app adoption and use, its potential advantages and privacy-preserving mechanisms need to be stressed. Building further knowledge on the forms of resistance among nonusers is important for responding to these barriers through the app’s further development and communication campaigns.

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