Characteristics and determinants of population acceptance of COVID-19 digital contact tracing: a systematic review

Characteristics and determinants of population acceptance of COVID-19 digital contact tracing: a systematic review


  • Leonardo Pegollo
  • Elena Maggioni
  • Maddalena Gaeta
  • Anna Odone


digital contact tracing, acceptance, systematic review, COVID-19


Background and aim: As recently outlined in the WHO-ECDC Indicator framework (1) to evaluate the public health effectiveness of digital proximity tracing solutions, one of the main barriers to digital contact tracing (DCT) is population acceptance, which, in turns, is influenced by digital literacy, attitudes and practice. DCT came to public prominence during the COVID-19 pandemic but evidence on its population acceptance have not been comprehensively analyzed. 

Methods: We carried out a systematic review (PROSPERO: CRD42021253668) following the PRISMA guidelines to collect, systematize and critically appraise the available evidence on population DCT acceptance.  Original studies reporting on different measures of population DCT acceptance were included.

Conclusions: The systematic review was based on 41 articles meeting our a priori defined inclusion criteria, comprising aa total of 186144 surveyed subjects, 50000 tweets, 5025 Reddit posts and 714 written comments. Data extraction and synthesis required a qualitative outcome grouping, performed ex-post, in 14 different benchmarks components. They constitute a narrative analysis of actionable points for public health policy. Population acceptance is a key component of  DCT effective adoption and infection control during infectious diseases outbreaks. Assessing DCT acceptance’s determinants in different settings, populations an cultural contexts it is of fundamental importance to inform the planning, implementation and monitoring of public health interventions.

The results of our in-depth qualitative and quantitative analysis  will provide context for prospective improvements and actionable items and should guide future research aimed at exploring how digitalization can serve people-centred care.


Exposure Notifications Frequently Asked Questions [Internet]. 2020 [cited 2021 May 5]. Available from:

Ferretti L, Wymant C, Kendall M, Zhao L, Nurtay A, Abeler-Dörner L, et al. Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing. Science. 2020 May 8;368(6491).

Grekousis G, Liu Y. Digital contact tracing, community uptake, and proximity awareness technology to fight COVID-19: a systematic review. Sustainable Cities and Society. 2021 Aug;71:102995.

Moreno López JA, García BA, Bentkowski P, Bioglio L, Pinotti F, Boëlle P-Y, et al. Anatomy of digital contact tracing: Role of age, transmission setting, adoption and case detection. Sci Adv. 2021 Mar 12;

Cencetti G, Santin G, Longa A, Pigani E, Barrat A, Cattuto C, et al. Using real-world contact networks to quantify the effectiveness of digital contact tracing and isolation strategies for Covid-19 pandemic. medRxiv. 2020 May 30;

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372:n71.

Viswanathan M, Berkman ND. Development of the RTI item bank on risk of bias and precision of observational studies. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011.

Viswanathan M, Berkman ND, Dryden DM, Hartling L. Assessing risk of bias and confounding in observational studies of interventions or exposures: further development of the RTI item bank. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013.

Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020 Jan 16;368:l6890.

Montagni I, Roussel N, Thiébaut R, Tzourio C. Health Care Students’ Knowledge of and Attitudes, Beliefs, and Practices Toward the French COVID-19 App: Cross-sectional Questionnaire Study. J Med Internet Res. 2021 Mar 3;23(3):e26399.

Zimmermann BM, Fiske A, Prainsack B, Hangel N, McLennan S, Buyx A. Early Perceptions of COVID-19 Contact Tracing Apps in German-Speaking Countries: Comparative Mixed Methods Study. J Med Internet Res. 2021 Feb 8;23(2):e25525.

Garrett PM, White JP, Lewandowsky S, Kashima Y, Perfors A, Little DR, et al. The acceptability and uptake of smartphone tracking for COVID-19 in Australia. PLoS ONE. 2021 Jan 22;16(1):e0244827.

Bachtiger P, Adamson A, Quint JK, Peters NS. Belief of having had unconfirmed Covid-19 infection reduces willingness to participate in app-based contact tracing. npj Digital Med. 2020 Nov 6;3(1):146.

Garrett PM, Wang Y, White JP, Hsieh S, Strong C, Lee Y-C, et al. Young Adults View Smartphone Tracking Technologies for COVID-19 as Acceptable: The Case of Taiwan. Int J Environ Res Public Health. 2021 Feb 2;18(3).

Giansanti D, Veltro G. The Digital Divide in the Era of COVID-19: An Investigation into an Important Obstacle to the Access to the mHealth by the Citizen. Healthcare (Basel). 2021 Mar 26;9(4).

Blom AG, Wenz A, Cornesse C, Rettig T, Fikel M, Friedel S, et al. Barriers to the Large-Scale Adoption of a COVID-19 Contact Tracing App in Germany: Survey Study. J Med Internet Res. 2021 Mar 2;23(3):e23362.

von Wyl V, Höglinger M, Sieber C, Kaufmann M, Moser A, Serra-Burriel M, et al. Drivers of Acceptance of COVID-19 Proximity Tracing Apps in Switzerland: Panel Survey Analysis. JMIR Public Health Surveill. 2021 Jan 6;7(1):e25701.

Rekanar K, O’Keeffe IR, Buckley S, Abbas M, Beecham S, Chochlov M, et al. Sentiment analysis of user feedback on the HSE’s Covid-19 contact tracing app. Ir J Med Sci. 2021 Feb 18;

Sharma N, Basu S, Sharma P. Sociodemographic determinants of the adoption of a contact tracing application during the COVID-19 epidemic in Delhi, India. Health Policy and Technology. 2021 Mar;100496.

Horstmann KT, Buecker S, Krasko J, Kritzler S, Terwiel S. Who does or does not use the “Corona-Warn-App” and why? Eur J Public Health. 2021 Feb 1;31(1):49–51.

Thomas R, Michaleff ZA, Greenwood H, Abukmail E, Glasziou P. Concerns and Misconceptions About the Australian Government’s COVIDSafe App: Cross-Sectional Survey Study. JMIR Public Health Surveill. 2020 Nov 4;6(4):e23081.

Kaspar K. Motivations for Social Distancing and App Use as Complementary Measures to Combat the COVID-19 Pandemic: Quantitative Survey Study. J Med Internet Res. 2020 Aug 27;22(8):e21613.

Mouter N, Collewet M, de Wit GA, Rotteveel A, Lambooij MS, Kessels R. Societal Effects Are a Major Factor for the Uptake of the Coronavirus Disease 2019 (COVID-19) Digital Contact Tracing App in The Netherlands. Value Health. 2021 May;24(5):658–67.

Munzert S, Selb P, Gohdes A, Stoetzer LF, Lowe W. Tracking and promoting the usage of a COVID-19 contact tracing app. Nat Hum Behav. 2021 Feb;5(2):247–55.

Kawakami N, Sasaki N, Kuroda R, Tsuno K, Imamura K. The Effects of Downloading a Government-Issued COVID-19 Contact Tracing App on Psychological Distress During the Pandemic Among Employed Adults: Prospective Study. JMIR Ment Health. 2021 Jan 12;8(1):e23699.

Abuhammad S, Khabour OF, Alzoubi KH. COVID-19 Contact-Tracing Technology: Acceptability and Ethical Issues of Use. Patient Prefer Adherence. 2020 Sep 18;14:1639–47.

S.V. P, Ittamalla R, Subramanian D. How optimistic do citizens feel about digital contact tracing? – Perspectives from developing countries. IJPCC. 2020 Nov 6;ahead-of-print(ahead-of-print).

Janz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q. 1984;11(1):1–47.

Abraham C, Sheeran P. The health belief model. In: Ayers S, Baum A, McManus C, Newman S, Wallston K, Weinman J, et al., editors. Cambridge handbook of psychology, health and medicine. Cambridge University Press; 2001. p. 97–102.

Altmann S, Milsom L, Zillessen H, Blasone R, Gerdon F, Bach R, et al. Acceptability of App-Based Contact Tracing for COVID-19: Cross-Country Survey Study. JMIR Mhealth Uhealth. 2020 Aug 28;8(8):e19857.

Oldeweme A, Märtins J, Westmattelmann D, Schewe G. The Role of Transparency, Trust, and Social Influence on Uncertainty Reduction in Times of Pandemics: Empirical Study on the Adoption of COVID-19 Tracing Apps. J Med Internet Res. 2021 Feb 8;23(2):e25893.

Camacho-Rivera M, Islam JY, Rivera A, Vidot DC. Attitudes Toward Using COVID-19 mHealth Tools Among Adults With Chronic Health Conditions: Secondary Data Analysis of the COVID-19 Impact Survey. JMIR Mhealth Uhealth. 2020 Dec 17;8(12):e24693.

Wnuk A, Oleksy T, Maison D. The acceptance of Covid-19 tracking technologies: The role of perceived threat, lack of control, and ideological beliefs. PLoS ONE. 2020 Sep 11;15(9):e0238973.

Zhang M, Chow A, Smith H. COVID-19 Contact-Tracing Apps: Analysis of the Readability of Privacy Policies. J Med Internet Res. 2020 Dec 3;22(12):e21572.

Zhang B, Kreps S, McMurry N, McCain RM. Americans’ perceptions of privacy and surveillance in the COVID-19 pandemic. PLoS ONE. 2020 Dec 23;15(12):e0242652.

Guillon M, Kergall P. Attitudes and opinions on quarantine and support for a contact-tracing application in France during the COVID-19 outbreak. Public Health. 2020 Nov;188:21–31.

Maytin L, Maytin J, Agarwal P, Krenitsky A, Krenitsky J, Epstein RS. Attitudes and Perceptions Toward COVID-19 Digital Surveillance: Survey of Young Adults in the United States. JMIR Formativ Res. 2021 Jan 8;5(1):e23000.

Volume 3 WHO. mHealth: New horizons for health through mobile technologies. Switzerland: World Health Organization; 2011.

Matt C. Campaigning for the greater good? – How persuasive messages affect the evaluation of contact tracing apps. Journal of Decision Systems. 2021 Feb 28;1–18.

S.V. P, Ittamalla R. General public’s attitude toward governments implementing digital contact tracing to curb COVID-19 – a study based on natural language processing. IJPCC. 2020 Sep 30;ahead-of-print(ahead-of-print).

Romero RA, Young SD. Ethical perspectives in sharing digital data for public health surveillance before and shortly after the onset of the Covid-19 pandemic. Ethics Behav. 2021 Mar 4;1–10.

Bradshaw EL, Ryan RM, Noetel M, Saeri AK, Slattery P, Grundy E, et al. Information Safety Assurances Increase Intentions to Use COVID-19 Contact Tracing Applications, Regardless of Autonomy-Supportive or Controlling Message Framing. Front Psychol. 2020;11:591638.

Bente BE, van ’t Klooster J-WJR, Schreijer MA, Berkemeier L, van Gend JE, Slijkhuis PJH, et al. The Dutch CoronaMelder: Do users see added value? JMIR Formativ Res. 2021 Mar 15;

S.V. P, Ittamalla R, Subramanian D. Challenges in successful implementation of Digital contact tracing to curb COVID-19 from global citizen’s perspective: A text analysis study. IJPCC. 2020 Oct 28;ahead-of-print(ahead-of-print).

Keshet Y. Fear of panoptic surveillance: using digital technology to control the COVID-19 epidemic. Isr J Health Policy Res. 2020 Nov 25;9(1):67.

What is Cybersecurity? | IBM [Internet]. [cited 2021 Aug 23]. Available from:

Benham JL, Lang R, Kovacs Burns K, MacKean G, Léveillé T, McCormack B, et al. Attitudes, current behaviours and barriers to public health measures that reduce COVID-19 transmission: A qualitative study to inform public health messaging. PLoS ONE. 2021 Feb 19;16(2):e0246941.

Scherr TF, DeSousa J, Moore C, Hardcastle A, Wright DW. App Usage and Usability Impressions of a Barcode-Based Digital Contact Tracing Platform for COVID-19: Survey Study. JMIR Public Health Surveill. 2021 Jan 16;

Rodríguez P, Graña S, Alvarez-León EE, Battaglini M, Darias FJ, Hernán MA, et al. A population-based controlled experiment assessing the epidemiological impact of digital contact tracing. Nat Commun. 2021 Jan 26;12(1):587.

Li T, Cobb C, Yang J (Junrui), Baviskar S, Agarwal Y, Li B, et al. What makes people install a COVID-19 contact-tracing app? Understanding the influence of app design and individual difference on contact-tracing app adoption intention. Pervasive Mob Comput. 2021 Aug;75:101439.

Azzopardi-Muscat N, Ricciardi W, Odone A, Buttigieg S, Zeegers Paget D. Digitalization: potentials and pitfalls from a public health perspective. Eur J Public Health. 2019 Oct 1;29(Supplement_3):1–2.

Odone A, Buttigieg S, Ricciardi W, Azzopardi-Muscat N, Staines A. Public health digitalization in Europe. Eur J Public Health. 2019 Oct 1;29(Supplement_3):28–35.

Balzarini F, Frascella B, Oradini-Alacreu A, Gaetti G, Lopalco PL, Edelstein M, et al. Does the use of personal electronic health records increase vaccine uptake? A systematic review. Vaccine. 2020 Aug 27;38(38):5966–78.

Frascella B, Oradini-Alacreu A, Balzarini F, Signorelli C, Lopalco PL, Odone A. Effectiveness of email-based reminders to increase vaccine uptake: a systematic review. Vaccine. 2020 Jan 16;38(3):433–43.




How to Cite

Pegollo L, Maggioni E, Gaeta M, Odone A. Characteristics and determinants of population acceptance of COVID-19 digital contact tracing: a systematic review. Acta Biomed [Internet]. 2021 Dec. 10 [cited 2024 Jul. 20];92(S6):e2021444. Available from: