scholarly journals Contact Tracing and the COVID-19 Response in Africa: Best Practices, Key Challenges, and Lessons Learned from Nigeria, Rwanda, South Africa, and Uganda

2021 ◽  
Author(s):  
Jean B. Nachega ◽  
Rhoda Atteh ◽  
Chikwe Ihekweazu ◽  
Nadia A. Sam-Agudu ◽  
Prisca Adejumo ◽  
...  
Keyword(s):  
Public Health ◽  
South Africa ◽  
Best Practices ◽  
Community Education ◽  
Health Workers ◽  
Face Mask ◽  
Lessons Learned ◽  
Contact Tracing ◽  
Political Commitment ◽  
African Countries

Most African countries have recorded relatively lower COVID-19 burdens than Western countries. This has been attributed to early and strong political commitment and robust implementation of public health measures, such as nationwide lockdowns, travel restrictions, face mask wearing, testing, contact tracing, and isolation, along with community education and engagement. Other factors include the younger population age strata and hypothesized but yet-to-be confirmed partially protective cross-immunity from parasitic diseases and/or other circulating coronaviruses. However, the true burden may also be underestimated due to operational and resource issues for COVID-19 case identification and reporting. In this perspective article, we discuss selected best practices and challenges with COVID-19 contact tracing in Nigeria, Rwanda, South Africa, and Uganda. Best practices from these country case studies include sustained, multi-platform public communications; leveraging of technology innovations; applied public health expertise; deployment of community health workers; and robust community engagement. Challenges include an overwhelming workload of contact tracing and case detection for healthcare workers, misinformation and stigma, and poorly sustained adherence to isolation and quarantine. Important lessons learned include the need for decentralization of contact tracing to the lowest geographic levels of surveillance, rigorous use of data and technology to improve decision-making, and sustainment of both community sensitization and political commitment. Further research is needed to understand the role and importance of contact tracing in controlling community transmission dynamics in African countries, including among children. Also, implementation science will be critically needed to evaluate innovative, accessible, and cost-effective digital solutions to accommodate the contact tracing workload.

scholarly journals Exploring the promise and reality of ward-based primary healthcare outreach teams conducting TB household contact tracing in three districts of South Africa

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256033
Author(s):  
Candice M. Chetty-Makkan ◽  
Daniel deSanto ◽  
Richard Lessells ◽  
Salome Charalambous ◽  
Kavindhran Velen ◽  
...  
Keyword(s):  
South Africa ◽  
Health Workers ◽  
Monitoring And Evaluation ◽  
Household Contact ◽  
Lessons Learned ◽  
Control Measures ◽  
Contact Tracing ◽  
Team Members ◽  
Home Based

Background Tuberculosis (TB) household contact tracing is a form of targeted active case-finding for which community health workers (‘outreach teams’) in South Africa are primarily responsible for its implementation. We conducted an exploratory qualitative study to understand the role of outreach teams in delivering TB household contact tracing. Methods The study took place in three districts of South Africa between May 2016 and February 2017. We conducted 78 in-depth interviews (IDI) (comprising 35 key stakeholders, 31 TB index patients and 12 HHCs) and five focus group discussions (FGD) (40 outreach team members in four FGDs and 12 community stakeholders in one FGD). Results Outreach teams contributed positively by working across health-related programmes, providing home-based care and assisting with tracing of persons lost to TB care. However, outreach teams had a limited focus on TB household contact tracing activities, likely due to the broad scope of their work and insufficient programmatic support. Outreach teams often confused TB household contact tracing activities with finding persons lost to TB care. The community also had some reservations on the role of outreach teams conducting TB household contact tracing activities. Conclusions Creating awareness among outreach workers and clinic personnel about the importance of and activities related to TB household contact tracing would be required to strengthen the delivery of TB household contact tracing through the community-based primary health care teams. We need better monitoring and evaluation systems, stronger integration within a realistic scope of work, adequate training on TB household contact tracing and TB infection prevention control measures. Involving the community and educating them on the role of outreach teams could improve acceptance of future activities. These timely results and lessons learned should inform contact tracing approaches in the context of COVID-19.

scholarly journals Climate Change and Health Preparedness in Africa: Analysing Trends in Six African Countries

2021 ◽  
Vol 18 (9) ◽  
pp. 4672
Author(s):  
Samuel Kwasi Opoku ◽  
Walter Leal Filho ◽  
Fudjumdjum Hubert ◽  
Oluwabunmi Adejumo
Keyword(s):  
Public Health ◽  
Climate Change ◽  
South Africa ◽  
Human Health ◽  
Health Systems ◽  
Health Professionals ◽  
Health Problems ◽  
Sub Saharan Africa ◽  
Basic Knowledge ◽  
African Countries

Climate change is a global problem, which affects the various geographical regions at different levels. It is also associated with a wide range of human health problems, which pose a burden to health systems, especially in regions such as Africa. Indeed, across the African continent public health systems are under severe pressure, partly due to their fragile socioeconomic conditions. This paper reports on a cross-sectional study in six African countries (Ghana, Nigeria, South Africa, Namibia, Ethiopia, and Kenya) aimed at assessing their vulnerabilities to climate change, focusing on its impacts on human health. The study evaluated the levels of information, knowledge, and perceptions of public health professionals. It also examined the health systems’ preparedness to cope with these health hazards, the available resources, and those needed to build resilience to the country’s vulnerable population, as perceived by health professionals. The results revealed that 63.1% of the total respondents reported that climate change had been extensively experienced in the past years, while 32% claimed that the sampled countries had experienced them to some extent. Nigerian respondents recorded the highest levels (67.7%), followed by Kenya with 66.6%. South Africa had the lowest level of impact as perceived by the respondents (50.0%) when compared with the other sampled countries. All respondents from Ghana and Namibia reported that health problems caused by climate change are common in the two countries. As perceived by the health professionals, the inadequate resources reiterate the need for infrastructural resources, medical equipment, emergency response resources, and technical support. The study’s recommendations include the need to improve current policies at all levels (i.e., national, regional, and local) on climate change and public health and to strengthen health professionals’ skills. Improving the basic knowledge of health institutions to better respond to a changing climate is also recommended. The study provides valuable insights which may be helpful to other nations in Sub-Saharan Africa.

Data-driven inferences of agency-level risk and response communication on COVID-19 through social media-based interactions

2021 ◽  
Vol 19 (7) ◽  
pp. 59-82
Author(s):  
Md Ashraf Ahmed, PhD Candidate ◽  
Arif Mohaimin Sadri, PhD ◽  
M. Hadi Amini, PhD, DEng
Keyword(s):  
Public Health ◽  
Social Media ◽  
Information Dissemination ◽  
Topic Model ◽  
Face Mask ◽  
Community Response ◽  
Machine Learning Algorithms ◽  
Data Driven ◽  
Contact Tracing ◽  
Online Social Media

Risk perception and risk averting behaviors of public agencies in the emergence and spread of COVID-19 can be retrieved through online social media (Twitter), and such interactions can be echoed in other information outlets. This study collected time-sensitive online social media data and analyzed patterns of health risk communication of public health and emergency agencies in the emergence and spread of novel coronavirus using data-driven methods. The major focus is toward understanding how policy-making agencies communicate risk and response information through social media during a pandemic and influence community response—ie, timing of lockdown, timing of reopening, etc.—and disease outbreak indicators—ie, number of confirmed cases and number of deaths. Twitter data of six major public organizations (1,000-4,500 tweets per organization) are collected from February 21, 2020 to June 6, 2020. Several machine learning algorithms, including dynamic topic model and sentiment analysis, are applied over time to identify the topic dynamics over the specific timeline of the pandemic. Organizations emphasized on various topics—eg, importance of wearing face mask, home quarantine, understanding the symptoms, social distancing and contact tracing, emerging community transmission, lack of personal protective equipment, COVID-19 testing and medical supplies, effect of tobacco, pandemic stress management, increasing hospitalization rate, upcoming hurricane season, use of convalescent plasma for COVID-19 treatment, maintaining hygiene, and the role of healthcare podcast in different timeline. The findings can benefit emergency management, policymakers, and public health agencies to identify targeted information dissemination policies for public with diverse needs based on how local, federal, and international agencies reacted to COVID-19.

The complication of cyber manhunt: How cyber manhunt further complicated the ethical conflict between breaching the confidentiality and endangering the society in face of the COVID-19 pandemic (Preprint)

2021 ◽  
Author(s):  
Yen-Chang Chen ◽  
Yen-Yuan Chen
Keyword(s):  
Public Health ◽  
Large Scale ◽  
Health Workers ◽  
Early Stage ◽  
Personal Information ◽  
Public Health Intervention ◽  
Contact Tracing ◽  
Online Activity ◽  
Contact Investigation ◽  
The Impact

UNSTRUCTURED While health care and public health workers are working on measures to mitigate the COVID-19 pandemic, there is an unprecedentedly large number of people spending much more time indoors, and relying heavily on the Internet as their lifeline. What has been overlooked is the influence of the increasing online activities on public health issues. In this article, we pointed out how a large-scale online activity called cyber manhunt may threaten to offset the efficacy of contact tracing investigation, a public health intervention considered highly effective in limiting further transmission in the early stage of a highly contagious disease outbreak such as the COVID-19 pandemic. In the first section, we presented a case to show how personal information obtained from contact investigation and disclosed in part on the media provoked a vehement cyber manhunt. We then discussed the possible reasons why netizens collaborate to reveal anonymized personal information about contact investigation, and specify, from the perspective of public health and public health ethics, four problems of cyber manhunt, including the lack of legitimate public health goals, the concerns about privacy breach, the impact of misinformation, and social inequality. Based on our analysis, we concluded that more moral weight may be given to protecting one's confidentiality, especially in an era with the rapid advance of digital and information technologies.

scholarly journals Challenges in Contact Tracing by Mining Mobile Phone Location Data for COVID-19: Implications for Public Governance in South Africa

10.28945/4736 ◽  
2021 ◽  
Vol 16 ◽  
pp. 101-124
Author(s):  
Paul Kariuki ◽  
Lizzy O Ofusori ◽  
Prabhakar Rontala Subramanniam ◽  
Moses Okpeku ◽  
Maria L Goyayi
Keyword(s):  
Public Health ◽  
South Africa ◽  
Mobile Phone ◽  
Contact Tracing ◽  
Future Research ◽  
Public Governance ◽  
The Public ◽  
Location Data ◽  
Pertinent Data ◽  
Privacy And Confidentiality

Aim/Purpose: The paper’s objective is to examine the challenges of using the mobile phone to mine location data for effective contact tracing of symptomatic, pre-symptomatic, and asymptomatic individuals and the implications of this technology for public health governance. Background: The COVID-19 crisis has created an unprecedented need for contact tracing across South Africa, requiring thousands of people to be traced and their details captured in government health databases as part of public health efforts aimed at breaking the chains of transmission. Contact tracing for COVID-19 requires the identification of persons who may have been exposed to the virus and following them up daily for 14 days from the last point of exposure. Mining mobile phone location data can play a critical role in locating people from the time they were identified as contacts to the time they access medical assistance. In this case, it aids data flow to various databases designated for COVID-19 work. Methodology: The researchers conducted a review of the available literature on this subject drawing from academic articles published in peer-reviewed journals, research reports, and other relevant national and international government documents reporting on public health and COVID-19. Document analysis was used as the primary research method, drawing on the case studies. Contribution: Contact tracing remains a critical strategy in curbing the deadly COVID-19 pandemic in South Africa and elsewhere in the world. However, given increasing concern regarding its invasive nature and possible infringement of individual liberties, it is imperative to interrogate the challenges related to its implementation to ensure a balance with public governance. The research findings can thus be used to inform policies and practices associated with contact tracing in South Africa. Findings: The study found that contact tracing using mobile phone location data mining can be used to enforce quarantine measures such as lockdowns aimed at mitigating a public health emergency such as COVID-19. However, the use of technology can expose the public to criminal activities by exposing their locations. From a public governance point of view, any exposure of the public to social ills is highly undesirable. Recommendations for Practitioners: In using contact tracing apps to provide pertinent data location caution needs to be exercised to ensure that sensitive private information is not made public to the extent that it compromises citizens’ safety and security. The study recommends the development and implementation of data use protocols to support the use of this technology, in order to mitigate against infringement of individual privacy and other civil liberties. Recommendation for Researchers: Researchers should explore ways of improving digital applications in order to improve the acceptability of the use of contact tracing technology to manage pandemics such as COVID-19, paying attention to ethical considerations. Impact on Society: Since contact tracing has implications for privacy and confidentiality it must be conducted with caution. This research highlights the challenges that the authorities must address to ensure that the right to privacy and confidentiality is upheld. Future Research: Future research could focus on collecting primary data to provide insight on contact tracing through mining mobile phone location data. Research could also be conducted on how app-based technology can enhance the effectiveness of contact tracing in order to optimize testing and tracing coverage. This has the potential to minimize transmission whilst also minimizing tracing delays. Moreover, it is important to develop contact tracing apps that are universally inter-operable and privacy-preserving.

Learning Through Practice: The Design and Implementation of an Advanced Integrative Practicum for DrPH Students

2020 ◽  
pp. 237337992093189
Author(s):  
Bree L. Hemingway ◽  
Jamie Q. Felicitas-Perkins ◽  
C. Anderson Johnson ◽  
Michael Osur ◽  
Darleen V. Peterson ◽  
...  
Keyword(s):  
Public Health ◽  
Best Practices ◽  
Health System ◽  
Qualitative Data ◽  
Lessons Learned ◽  
Health Issues ◽  
Professional Programs ◽  
Practice Experience ◽  
High Level ◽  
External Entity

Students enrolled in Doctor of Public Health (DrPH) programs accredited by the Council on Education for Public Health complete an applied practice experience resulting in an advanced project. This requirement can vary by program, but it commonly occurs as a singular experience after students have begun coursework. In 2016, we assessed the practicum component for the Doctor of Public Health degree at Claremont Graduate University. We sought feedback from employers and reviewed other professional programs with required practice experiences. Data indicated that successful experiences integrated didactic coursework with practice, suggesting the design of an embedded format versus a stand-alone requirement. The Advanced Integrative Practicum (AIP) was launched in Fall 2017 through a partnership between Claremont Graduate University School of Community and Global Health and Riverside University Health System. The practicum series began with an introduction to the health system through rotations led by Riverside University Health System (AIP-A), continued with students engaging with experts to propose solutions to public health issues (AIP-B), and concluded with a high-level practice-based project (AIP-C) where students, under supervision of a mentor at an external entity, implement projects. Qualitative data obtained through final written syntheses indicated that a majority of students feel the experience was integral to their DrPH training. Steps were taken to address threats to sustainability and a program component that seemed not sufficiently engaging. Although the practicum was not continued in its piloted form, best practices were realized as were lessons learned, ultimately leading to broader modifications in the DrPH program curriculum.

scholarly journals Multi-locus sequence analyses reveal a clonal L. borgpetersenii genotype in a heterogeneous invasive Rattus spp. community across the City of Johannesburg, South Africa

2020 ◽  
Author(s):  
Mark Hamish Moseley ◽  
Kovashnee Naidoo ◽  
Armanda Bastos ◽  
Liezl Retief ◽  
John Frean ◽  
...  
Keyword(s):  
Public Health ◽  
South Africa ◽  
Disease Risk ◽  
Cape Town ◽  
Infection Prevalence ◽  
Invasion History ◽  
Sequence Analyses ◽  
African Countries ◽  
Significant Public Health ◽  
The City

Abstract Background Rattus spp. are frequently implicated as key reservoir hosts for leptospirosis, one of the most common, but neglected, bacterial zoonoses in the world. Although leptospirosis is predicted to be a significant public health threat in Africa, studies from the continent are limited. Methods Rattus spp. (n=171) were sampled (January-May 2016) across the City of Johannesburg, South Africa’s largest inland metropole. Rattus spp. genetic diversity was evaluated by full length (1140 bp) cyt b sequencing of 42 samples. For comparison, a further 12 R. norvegicus samples collected in Cape Town, South Africa’s largest coastal metropole, were also genotyped. Leptospira infections were identified and genotyped using real-time PCR and multi-locus (lfb1, secY, lipL41) DNA sequencing. Results Five R. norvegicus haplotypes were identified across Johannesburg, four of which have not previously been detected in South Africa, and one in Cape Town. Across Johannesburg we identified a Leptospira spp. infection prevalence of 44% (75/171) and noted significant differences in the prevalence between administrative regions within the metropole. Multi-locus sequence analyses identified a clonal genotype consistent with L. borgpetersenii serogroup Javanica (serovar Ceylonica).Discussion The prevalence of infection identified in this study is amongst the highest detected in Rattus spp. in similar contexts across Africa. Despite the complex invasion history suggested by the heterogeneity in R. norvegicus haplotypes identified in Johannesburg, a single L. borgpetersenii genotype was identified in all infected rodents. The lack of L. interrogans in a rodent community dominated by R. norvegicus is notable given the widely recognised host-pathogen association between these species and evidence for L. interrogans infection in R. norvegicus in Cape Town. It is likely that environmental conditions (cold, dry winters) in Johannesburg may limit the transmission of L. interrogans. Spatial heterogeneity in prevalence suggest that local factors, such as land use, influence disease risk in the metropole. Conclusion In South Africa, as in other African countries, leptospirosis is likely underdiagnosed. The high prevalence of infection in urban rodents in Johannesburg suggest that further work is urgently needed to understand the potential public health risk posed by this neglected zoonotic pathogen.

scholarly journals Multi-locus sequence analyses reveal a clonal L. borgpetersenii genotype in a heterogeneous invasive Rattus spp. community across the City of Johannesburg, South Africa

2020 ◽  
Author(s):  
Mark Hamish Moseley ◽  
Kovashnee Naidoo ◽  
Armanda Bastos ◽  
Liezl Retief ◽  
John Frean ◽  
...  
Keyword(s):  
Public Health ◽  
South Africa ◽  
Disease Risk ◽  
Cape Town ◽  
Infection Prevalence ◽  
Invasion History ◽  
Sequence Analyses ◽  
African Countries ◽  
Significant Public Health ◽  
The City

Abstract BackgroundRattus spp. are frequently implicated as key reservoir hosts for leptospirosis, one of the most common, but neglected, bacterial zoonoses in the world. Although leptospirosis is predicted to be a significant public health threat in Africa, studies from the continent are limited. Methods Rattus spp. (n=171) were sampled (January-May 2016) across the City of Johannesburg, South Africa’s largest inland metropole. Rattus spp. genetic diversity was evaluated by full length (1140 bp) cyt b sequencing of 42 samples. For comparison, a further 12 R. norvegicus samples collected in Cape Town, South Africa’s largest coastal metropole, were also genotyped. Leptospira infections were identified and genotyped using real-time PCR and multi-locus (lfb1, secY, lipL41) DNA sequencing. Results Five R. norvegicus haplotypes were identified across Johannesburg, four of which have not previously been detected in South Africa, and one in Cape Town. Across Johannesburg we identified a Leptospira spp. infection prevalence of 44% (75/171) and noted significant differences in the prevalence between administrative regions within the metropole. Multi-locus sequence analyses identified a clonal genotype consistent with L. borgpetersenii serogroup Javanica (serovar Ceylonica).DiscussionThe prevalence of infection identified in this study is amongst the highest detected in Rattus spp. in similar contexts across Africa. Despite the complex invasion history suggested by the heterogeneity in R. norvegicus haplotypes identified in Johannesburg, a single L. borgpetersenii genotype was identified in all infected rodents. The lack of L. interrogans in a rodent community dominated by R. norvegicus is notable, given the widely recognised host-pathogen association between these species and evidence for L. interrogans infection in R. norvegicus in Cape Town. It is likely that environmental conditions (cold, dry winters) in Johannesburg may limit the transmission of L. interrogans. Spatial heterogeneity in prevalence suggest that local factors, such as land use, influence disease risk in the metropole. ConclusionIn South Africa, as in other African countries, leptospirosis is likely underdiagnosed. The high prevalence of infection in urban rodents in Johannesburg suggest that further work is urgently needed to understand the potential public health risk posed by this neglected zoonotic pathogen.

scholarly journals 102. Improving Implementation of HIV Pre-exposure Prophylaxis: Lessons Learned from Young Women in Rural South Africa

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S180-S181
Author(s):  
Alisse Hannaford ◽  
Noxolo Khumalo ◽  
Sarah Norton ◽  
Anthony Moll ◽  
Sheela Shenoi
Keyword(s):  
South Africa ◽  
Young Women ◽  
Health Workers ◽  
Lessons Learned ◽  
Rural Setting ◽  
Patient Centered ◽  
Inconsistent Condom ◽  
Healthcare Facilities ◽  
Exposure Prophylaxis ◽  
Delivery Models

Abstract Background Young women in South Africa are at particularly high risk for acquiring HIV, yet implementation of HIV prevention programmes in rural settings lags. We examined the experiences and perceptions of young women initiating pre-exposure prophylaxis (PrEP) in a rural setting under real-world programmatic conditions, in order to strengthen future PrEP delivery to this population. Methods Young women initiating PrEP in Msinga, a municipality in KwaZulu-Natal province, were interviewed about their motivation to start PrEP and their experiences in taking PrEP. Interviews were conducted at PrEP initiation and longitudinally as they returned to clinic monthly for medication refills. Results Among seventeen sexually active at-risk young women (IQR 18–22.5 years old) who initiated PrEP, 71% lived in a household receiving a government grant, 24% had history of an STI and 71% reported inconsistent condom use. All participants disclosed PrEP use to a family member, but only 20% informed their male sexual partner. All expressed uncertainty regarding their partners’ sexual activities as a primary motivation for PrEP initiation. Social support from family and friends as well as interacting with other young women taking PrEP were identified as important facilitators. Barriers to PrEP included lack of community awareness about PrEP, limited clinics offering PrEP, HIV stigma, and logistics of accessing healthcare facilities. Young women valued a peer PrEP champion to facilitate and maintain successful engagement in care, as well as patient-centered PrEP delivery models that allow for care outside traditional clinic facilities. Conclusion Input from young women has the potential to significantly enhance and expand PrEP implementation. Tailored implementation efforts should include strengthening the role of community health workers, improving community-wide PrEP education, empowering women within their relationships, facilitating skill building for PrEP disclosure to partners, incorporating community PrEP champions, and developing alternative PrEP delivery models including community-based delivery. Disclosures All Authors: No reported disclosures

scholarly journals The Dutch COVID-19 Contact Tracing App (the CoronaMelder): Usability Study

10.2196/27882 ◽  
2021 ◽  
Vol 5 (3) ◽  
pp. e27882
Author(s):  
Britt Elise Bente ◽  
Jan Willem Jaap Roderick van 't Klooster ◽  
Maud Annemarie Schreijer ◽  
Lea Berkemeier ◽  
Joris Elmar van Gend ◽  
...  
Keyword(s):  
Public Health ◽  
Older Adults ◽  
The Netherlands ◽  
Health Workers ◽  
Contact Tracing ◽  
Usability Tests ◽  
Health Authorities ◽  
Increased Risk ◽  
Public Health Authorities ◽  
Lower Education

Background Adoption and evaluation of contact tracing tools based on information and communications technology may expand the reach and efficacy of traditional contact tracing methods in fighting COVID-19. The Dutch Ministry of Health, Welfare and Sports initiated and developed CoronaMelder, a COVID-19 contact tracing app. This app is based on a Google/Apple Exposure Notification approach and aims to combat the spread of the coronavirus among individuals by notifying those who are at increased risk of infection due to proximity to someone who later tests positive for COVID-19. The app should support traditional contact tracing by faster tracing and greater reach compared to regular contact tracing procedures. Objective The main goal of this study is to investigate whether the CoronaMelder is able to support traditional contact tracing employed by public health authorities. To achieve this, usability tests were conducted to answer the following question: is the CoronaMelder user-friendly, understandable, reliable and credible, and inclusive? Methods Participants (N=44) of different backgrounds were recruited: youth with varying educational levels, youth with an intellectual disability, migrants, adults (aged 40-64 years), and older adults (aged >65 years) via convenience sampling in the region of Twente in the Netherlands. The app was evaluated with scenario-based, think-aloud usability tests and additional interviews. Findings were recorded via voice recordings, observation notes, and the Dutch User Experience Questionnaire, and some participants wore eye trackers to measure gaze behavior. Results Our results showed that the app is easy to use, although problems occurred with understandability and accessibility. Older adults and youth with a lower education level did not understand why or under what circumstances they would receive notifications, why they must share their key (ie, their assigned identifier), and what happens after sharing. In particular, youth in the lower-education category did not trust or understand Bluetooth signals, or comprehend timing and follow-up activities after a risk exposure notification. Older adults had difficulties multitasking (speaking with a public health worker and simultaneously sharing the key in the app). Public health authorities appeared to be unprepared to receive support from the app during traditional contact tracing because their telephone conversation protocol lacks guidance, explanation, and empathy. Conclusions The study indicated that the CoronaMelder app is easy to use, but participants experienced misunderstandings about its functioning. The perceived lack of clarity led to misconceptions about the app, mostly regarding its usefulness and privacy-preserving mechanisms. Tailored and targeted communication through, for example, public campaigns or social media, is necessary to provide correct information about the app to residents in the Netherlands. Additionally, the app should be presented as part of the national coronavirus measures instead of as a stand-alone app offered to the public. Public health workers should be trained to effectively and empathetically instruct users on how to use the CoronaMelder app.

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