Is there safety in numbers? Barriers to COVID-19 app adoption in Australia

It's often said that there’s safety in numbers, and when the Australian Government first launched the COVIDSafe app there was much talk about the necessity that 40 per cent of the population download it to keep us safe.

Written by Associate Professor Paul Cooper and Dieu Nguyen

After the initial early enthusiastic download of the COVIDSafe app, it looks as if the adoption curve has flattened with currently 6.5m downloads (only 25 per cent of the population), and the Government is no longer talking about any specific percentage adoption target. More broadly, the limited number of coronavirus cases in Australia means that the effectiveness of the COVIDSafe app is currently questionable. While COVIDSafe data has been used by contact tracing teams in recent weeks, it appears that data from the app has not yet led to the identification of any additional cases. There is a paradox here – if cases remain low, COVIDSafe may not be able to prove its worth, yet if numbers rise significantly, contact tracing systems (digital or manual) may rapidly become overwhelmed.

Some respected industry commentators (for example, Centre for Digital Business managing director Marie Johnson) are reported as blaming initial missteps in lack of transparency and lack of a clear concept of operations as partial reasons for this stalled adoption. The D-HEAL (Deakin Health E-technologies Assessment Lab) team team blogged early on our view that the COVIDSafe app was a credible effort but had aspects to be addressed with respect to transparency, and multi-lingual support. On 2 July, the Government released the app with support for multiple languages other than English – Arabic, Simplified and Traditional Chinese, Korean, and Vietnamese, which we have been able to verify based on our testing; but of additional concern is that the Government has not as yet apparently solved the limited performance of the iPhone version of the app.

The D-HEAL team has consistently called out the need for multiple language support in all health apps designed for use in Australia. “Australia, and particularly Victoria, is linguistically diverse, and through the most recent spike in COVID-19 cases in Melbourne, we are again facing the reality that understanding how to communicate with cultures in languages other than English is important to keep everyone safe,” says Associate Professor Martin Hensher, who leads the D-HEAL team.

“We commend the Migration Council for its MYAUSCOVID-19 app – which has tried to bridge this language gap – but mainstream app development for COVID-19 and other health apps must incorporate diverse linguistic needs much more deliberately in future.”

The D-HEAL team, which has been developing a framework for evaluating the effectiveness of mobile health apps, has strongly emphasises the importance of a good user interface that goes beyond monocultural single-language usage.

“Apart from multi-lingual usage, a good user interface for an effective mobile health app must be well-designed, must be tailored to the cultural norms of the expected users, including understanding that writing does not flow from left to right, top to bottom in all languages and that language norms affect how people scan the screen when looking for controls.

“In addition, the apps must be able to be operated by people with sight, hearing impairment or limited dexterity and ideally should work offline so that use in remote communities is enabled. This is something we value and rate highly in our evaluation framework,” says D-HEAL’s Associate Professor Paul Cooper.

Alas, the COVIDSafe app from the Australian Government is still (as of this date) only operational with internet connectivity via the phone – something that limits use in remote communities. Associate Professor Paul Cooper raised this shortcoming soon after the app’s launch.

Apart from COVIDSafe, the D-HEAL team has again looked more broadly at COVID-related apps that are usable in Australia and has evaluated them using our preliminary D-HEAL app evaluation framework. Senior researcher Dieu Nguyen identified that there are now a number of research-oriented apps available, including COVID-19 sound, which is a UK app designed to help detect a COVID-related cough. Most of the internationally available apps support multiple languages and this is something the D-HEAL team applauds.

The D-HEAL team notes the appearance of apps targeting mental health with a focus on COVID-19 and believes that this will be an emerging trend. We have identified three mental health apps with a COVID-19 focus such as iHelpSunshineCoast (iHelp), Managing your stress and anxiety, and COVID Coach; however, only iHelpSunshineCoast (iHelp) is an Australian owned app. Of note is that the three apps can be run offline for at least some features, such as meditation and general information and support, but disappointingly only support English as the user language.

Professor Anna Peeters, Director of Deakin’s Institute for Health Transformation explains that her team’s focus on Determinants of Health and Population Health has direct correlations to COVID-19.

“We know that where we live, work, play, and age, and how our society operates, has a major impact on our health and wellbeing. These factors, otherwise known as the social determinants of health, are modifiable and so can be changed for the better,” she says.

“Since COVID-19 impacts our lives in all these determinants, we expect to see an impact on mental health. Our research will continue to investigate ways to minimise the negative impacts of COVID-19, and having a framework to help us assess useful mobile health apps will be of broad societal benefit.”

The D-HEAL team will keep you informed as further apps emerge.