COVID-19 Tracking Applications Acceptance among General Populace: An Overview in Malaysia

Abstract

The COVID-19 pandemic forced governments to implement strategies for contact tracing due to the disease’s ease of spread. The Malaysian government has sought to develop and implement a digital contact-tracking application to make it easier and faster to detect the spread; the system has become an integral part of the exit strategy from mandated lockdowns. These applications keep track of the user’s proximity with others who are in the system to inform them early on if they are at a risk of infection. The effectiveness of these applications depends on the willingness of users to install and allow the application to track their location at all times. Therefore, this research aims to identify the factors that would stimulate or slow down the adoption of contact-tracing apps.

1. Introduction

In the absence of a vaccine or an effective treatment, the COVID-19 epidemic is the most dangerous threat facing humanity in the past 100 years [1]. This threat was not limited to public health only, but it also led to other challenges facing decision makers [2]. Governmental and health authorities have taken a set of measures that will reduce or prevent the spread of the virus across the country [3]. Initially, the measures have focused on non-pharmaceutical interventions to restrict the epidemic’s spread, such as physical distance, case isolation, and manual tracing of contacts [4]. These measures have not been enough to stop the virus outbreak [5]. Therefore, several countries have resorted to partial or complete ‘lockdown’ policies to contain the disease [6], significantly restricting their populations’ social and economic interactions [7]. Although lockdowns can enable countries to control the number of infections, they come at a high social and economic cost [8].

Governments have resorted to implementing effective strategies and measures for an exit from lockdown [9]. However, it was difficult to track COVID-19 with traditional methods [10], as cases infected with the virus may not show symptoms of the disease until two days after infection [11], so contacts become contagious on average 3–4 days after exposure [12]. Therefore, the feasibility of achieving containment by manual contact tracing is not effective.

Digital contact-tracing applications have been suggested by Ferretti and colleagues (2020) in [13] as a crucial approach to limit the virus without the significant societal and financial consequences of lockdowns. A tried-and-true method that has been widely used to stop infectious disease epidemics is contact tracing [14]. The goal is to utilize phone connections to track contacts that people have with others [15], including those that might increase the risk of spreading an infection (such as spending more than 15 min near one or two meters of another person) [16]. If a user is found to have COVID-19, the condition may be reported using the app, which will result in a cautious methodical warning to all other people who have come into close contact with the infected individual [17]. Then, individuals are instructed to either undergo an examination at the closest medical facility or to remain at home alone for a minimum of 14 days [18]. A new method of COVID-19 detection using body language and machine learning has been reviewed in [14,15].

This paper examines the operation of contact-tracking apps and analyzes the variables that may affect how well-received they are in society. This work also suggests ways to lessen the effects of the variables influencing users’ adoption of COVID-19 digital contact-tracing apps. These suggested solutions will also show how effectively digital contact-tracking applications may be used to stop the spread of COVID-19 and hasten the recovery process after the pandemic. The reviewed works are obtained through Google Scholar with the filtering criteria being COVID-19 and tracing, in addition to relevant keywords such as social media, security, and application risk acceptance.

2. Overview

2.1. Measures to Limit the Spread of COVID-19

There are many methods that the Malaysian government has approached to reduce the speed of the spread of the epidemic [16]: imposing travel restrictions, lockdown, and contact tracing (manual and digital); taking advantage of social media [17]; using the official website [18]; and issuing press reports regularly by the competent authorities [19]. These strategies contributed to limiting the spread of the disease and slowing down new cases in the Malaysian states [20].

2.1.1. Travel Restriction

Despite all these imposed measures, it was noted that the home quarantine order imposed by the authorities on travelers coming to Malaysia is not feasible for eliminating the spread of the disease [21]. They are not allowed to leave this home quarantine until after completing the specified period of 14 days [22]. This is due to the rapid rise in the number of infected cases from one-digit to two-digit numbers [23]. This rise is often contributed by travelers coming from outside the country who did not abide by the decision to home-quarantine [24]. Therefore, the authorities had to place these travelers in designated quarantine centers [25], in order to ensure that they do not mix with their relatives and the public [26].

The quarantine process adopted by the government is considered important and essential to complete the strict examination procedures upon the arrival of travelers [27], as symptoms of infection with the virus may not appear on the infected, despite the possibility that they are in the incubation period [28].

2.1.2. Movement Control

The Malaysian government decided to impose a movement control order for 2020, generally referred to as MCO [29], which is considered a sanitary cordon to be implemented as a preventive measure by the federal government of Malaysia [4], to reduce the effectiveness of the rapid transmission of the COVID-19 virus in the country on 18 March 2020 [30]. Local and international media referred to this event as a “lockdown” or “partial lockdown” [3]. However, the government had considerations to extend the lockdown until late April or May as the number of cases in Malaysia is expected to reach a peak in mid-April, according to the World Health Organization (WHO) [31].

On June 9, the government announced the termination of the conditional movement control order, in preparation for the country to enter the phase of the Recovery Movement Control Order (RMCO) between 10 June and 31 August [32]. Passengers were also allowed to move between states with the application of safety measures, except for some areas that are still subject to the Enhanced Movement Control Order (EMCO) [33].

2.1.3. Contact Tracing

Contact tracing for people infected with the virus and who have shown symptoms of illness is extremely important [34], to ensure that those in contact with these patients did not become infected, because the possibility of transmitting the infection to these contacts will be very great, and they may transmit it to other people [35]. The Malaysian government has developed a contact-tracing app to be available for use [4]. This application can be downloaded on the mobile phone and used by citizens to log in at all public places and transportation [36]. Moreover, the app contributes to the speed of the response of the contact-tracing process in the event of new COVID-19 cases in a specific zone [37].

2.1.4. Utilization of Official Website and Social Media

The government has benefited from the regular and rapid dissemination of information about the COVID-19 virus [18]. Regular publication is one of the procedures used previously to disseminate information about some infectious diseases [38]. Social media can be an ideal strategy to curb the spread of the epidemic [39]. The National Security Council of Malaysia has also played a role in disseminating information to the citizens about the COVID-19 contagion [32]. The agency enlisted the help of telecom service providers to spread news related to the epidemic using short messages and some messaging applications such as Telegram to all citizens [40].

This may be one of the appropriate news publishing options, because a group of residents still reside in areas with limited access to the Internet, and some may find it difficult to correspond via Internet applications [41], while there are also some people who do not own smartphones [42].

In addition, the Malaysian National Security Council co-ordinated with the communication providers by inserting a “Stay In, Stay Safe” message on the carrier ID display as a strategy to encourage people to stay at home during the lockdown time [43].

2.1.5. Regular Press Releases

The Malaysian Ministry of Health addressed the public daily during the COVID-19 pandemic period through visual (TV, YouTube), audio (radio), and written (official website) [32] media. It sought to deliver information with complete professionalism to people who live in various locations in the country [16]. The purpose of these letters is to inform citizens of the current situation of COVID-19 in Malaysia [19]. Numerous speeches were broadcast regularly and systematically by state television, so that citizens living in rural areas far from Internet services could obtain adequate information about the pandemic [20].

The Malaysian government has learned that the public’s awareness and high sensitivity towards the disease are essential complements to the government’s success in facing the epidemic [44]. Consequently, it intensified the official data and used different media outlets and in a variety of ways, all to communicate the necessary information to the citizens [29]. Therefore, regular press releases and the use of social media to spread information related to COVID-19 have played an effective role in mitigating the spread of the epidemic [3]. However, the government should take strict and extensive measures to impose deterrent penalties on people who violate standard operating procedures [45].

2.2. Manual Contact Tracing

Manual contact tracing is a method of infectious disease control by which we can identify individuals who may have been in contact with an infected person [46]. It is not a novel approach and has been carried out in previous pandemics, including SARS in 2003 and H1N1 in 2009 [8]. Manual contact tracing is the fastest public health response to reduce the prevalence of infection [47]. This strategy is usually used at the local level, so that data is shared with health authorities and decision makers at the local and regional levels [39].

Traditionally, contact tracing is carried out manually, beginning with an extensive interview and gathering the appropriate details from infected persons [48], such as places they visited and people they met during a certain period, and is considered related to the way the infection is transmitted to the infected [49]. Moreover, some data about contacts that health authorities have obtained can be used in an unspecified method to analyze and model the spread of infection as it may be important in developing a public health response [50]. With the high prevalence of infection of COVID-19 and the decline in pre-existing immunity resistance in the population, challenges have emerged for public health authorities [45]. It is imperative for these authorities to balance the rights of privacy and the public interest through the fact that the person providing this information has tested positive for the disease [6]. Therefore, the risk of infection with the virus for people close to him is very great [51].

Unfortunately, the disadvantages of manual contact tracing for the COVID-19 pandemic included the fact that most people typically struggle to remember most of the places they visited and the people they met within the previous two weeks before positive test results emerged [35]. This leads to inaccuracy and unreliability, and constitutes an obstacle for health authorities when tracking all contacts of the infected person [52]. In addition, these individuals may be able to remember some of their encounters with specific and known people such as family members, co-workers, and close friends [38], but they may have met many individuals with whom they have no connection and whose identities are unknown to them (for example, using public transportation or shopping in malls and stores) [53].

Considering the rapid development of technology, governments are racing to find appropriate solutions to eradicate this epidemic and exit the lockdown [11]. Therefore, it is not surprising that governments and organizations had begun to think about introducing technology as part of these solutions, to replace manual contact tracing [33].

2.3. Digital Contact Tracing

Previously, contact tracing was already used by some countries to slow the spread of viruses in the community [47], where contact tracing is considered among the measures followed to lift the “lockdown” [54]. Governments have sought to develop and introduce all measures to their health systems to combat such viruses [16]. Several techniques have been used to confront the epidemic spread around the world, and among these techniques is contact tracing [6]. Contact tracing was not only limited to tracing the contacts of the patient using the traditional method (manual) [39], but also, several applications were designed and developed [48]. Governments are working hard to develop these applications to be more effective [49]. It has been observed through previous experiences that traditional contact tracing has a set of defects that may affect the speed of responsiveness in limiting the spread of the virus [32]. Therefore, the Malaysian government has rushed to introduce digital contact-tracing apps into its exit strategy from the lockdown in the current COVID-19 crisis [44].

COVID-19 apps are applications developed and created programmatically for use in mobile devices [55], as these programs use digital tracking to help monitor and trace contacts and conduct an urgent and immediate response to the COVID-19 virus [56]. This means that it identifies people who were near the affected individual [57].

These applications are developed to be installed on the users’ phones or tablets to track when and where they communicate with each other and how long it takes to use the Bluetooth signal [53]. Some of these applications use location data to be determined by the Global Positioning System (GPS) [8]. Although they have the same purpose, they have different characteristics in terms of use; many governments have designed and implemented these applications in proportion to their countries [43]. The development of these applications were not limited to governments only [21], but major international companies sought to enter this race and have already designed digital tracking applications [2].

The Singaporean government released the first application to track digital contacts on 20 March 2020 under the name Trace Together App [2]. This software uses the Bluetooth communication monitoring of the handset to communicate with other nearby phones [31]. This experience has encouraged many governments around the world [58], including the Malaysian government, to develop a similar version of the working mechanism of the Trace Together App to be utilized in Malaysia to stem the spread of COVID-19 [23].

2.4. Mechanism of COVID-19 Digital Contact-Tracing Apps

Digital technologies have proven to be a source of strength for health workers in terms of the speed of response, data collection, and analysis [59]. Many digital technologies have been used to combat epidemics and viruses [60]. Digital contact-tracking technology has entered the public health field to reduce the risk of the virus spreading [35]. The mechanism of action of these applications helps to identify and evaluate interactions with individuals who have symptoms or their contacts [61]. Moreover, digital contact-tracing technology has participated in limiting the spread of the epidemic because early detection and reporting can help to break the chain of transmission of COVID-19 [62]. Digital tracking applications are gaining popularity in all countries of the world, as they are now considered the best way to monitor the transmission of COVID-19 [13]; here, we will show the various mechanisms used by digital contact-tracing apps for COVID-19 [39].

2.4.1. Identify

These apps first identify the person with symptoms of the COVID-19 virus [63], then confirm the identity of this user and that the results of the tests were positive and showed that he was really infected [64].

2.4.2. Contact Tracing

Contact tracing involves tracking contacts of people whose test results were positive and who were found to be carriers of the virus [65], and asking these contacts to exercise caution and follow all health procedures, including self-isolation, testing for COVID-19, and home quarantine [66]. During this period, the application provides advice and guidance and supports these contacts with appropriate information and advice [67].

2.4.3. Tracking

The apps track active cases and remote contacts of people who have symptoms of infection with COVID-19 (for example, public transportation, malls, shops, etc.) [68].

2.4.4. Monitor

The apps monitor the movement of these active cases (infected people), direct contacts, places of vital gatherings, quarantine areas, and confirmed gathering areas [69]. In addition, they monitor the health of people in areas containing the virus and red zones [55].

2.4.5. Advice

After the user is proven infected and a note is issued by the health authority that the results of the tests were positive, the patient is subject to isolation [54]. The counselors from the staff in government health agencies provide the necessary advice and alleviate the fears of the injured [70]. Moreover, they provide appropriate treatment if the patient suffers from some side effects because of fear or if he has chronic diseases [14], providing psychological support, reassuring the patient, and alleviating concerns about mental health [71].

2.4.6. Education and Information

These applications enable users to obtain health information about COVID-19 [22]. Moreover, they highlight the developments of the virus, its severity, and all information about it [41]. They also publish the latest recommendations issued by public health authorities on how to deal with the epidemic and what the necessary health measures are [72]. The applications are considered as official platforms for obtaining the most important health recommendations, advice, and self-care tools [73].

2.4.7. Research

Contact-tracing apps provide many services, including the ability for researchers to collect the data needed to conduct detailed studies of the epidemic [74]. Moreover, researchers are able to share epidemiological data for future preparation for the modeling study [25].

2.5. Importance of Contact Tracing for COVID-19

The entire world has been working to take every precaution to lessen the harm to society since the COVID-19 epidemic began at the end of 2019 [46]. The governments are trying to figure out how to trace contacts in order to isolate and identify sick people with ease [47]. Manual contact tracing is relatively slow, which slows down response times. In addition, it takes resources to locate virus-infected individuals [53], access their data and determine whether the data are accurate [40], ask for their contacts [41], and then contact those contacts to follow the spread of the epidemic [34]. In order to circumvent the drawbacks of human contact tracing, governments rapidly sought to make use of the technological advancements in smartphones [6], leading to the development of digital contact-tracing applications and introducing them as a crucial countermeasure to the disease’s propagation and a facilitator for the lockdown’s end [19].

By informing the injured of their seclusion and taking all necessary precautions to stop the spread of infection, digital contact-tracing applications help to slow the spread of the virus in its early stages [36]. These applications are important for tracking the contacts of patients who have symptoms, advising those individuals on self-isolation [75], perofrming the examination [76], and assisting them with the proper guidance and information [52] to get through the quarantine period.

Applications for tracking digital contacts are characterized by their accuracy and speed [35]. Since they have aided in enhancing response time [77], this made it the best course of action for many nations to stop the disease’s spread [70]. However, several governments encountered a number of issues when making the apps available to the public [44]. How well-liked these apps are among users will determine their success [21]. There are other phone apps that are riskier to privacy; however, we find a large demand for their use, therefore privacy concerns were not the sole barrier that limits the use of these programs [12]. People’s privacy worries are lessened and they are more willing to provide personal information in such situations [43]. Even though these worries are minor, they are nonetheless viewed as one of the difficulties that might hinder the public’s acceptance of the application [75].

2.6. Public Interest Impact in Accepting Contact-Tracing Apps

Malaysia has experienced the COVID-19 pandemic’s effects since it began, just as the rest of the world has [73]. The Malaysian government made many attempts to combat the epidemic [25]. It mobilized all of its resources to contain this epidemic [40]. To lessen this risk, it was yet necessary to raise awareness among the populace and clarify what was meant by “public interest” [38]. The definition of this phrase is “universal peace, public rights, and welfare that are to be known, preserved, and promoted” [78]. Events acquire the quality of “public interest” when they have an impact on individuals’ lives and have an impact on the public or a group of community members [79], when a number of issues of public interest are raised, or when the effects of these issues on particular social groups, “such as marginalized groups,” become apparent [51].

We can conclude that it can be regarded as a matter of public interest given the pandemic’s influence on the general population across the nation and the spread of the disease among society’s members [50]. To slow the spread of the virus, governments face a particularly difficult challenge in persuading consumers to use digital contact-tracing tools [32]. Based on the public interest during this epidemic, the disclosure of personal information for digital contact-tracking applications and the disclosure of personal information for other smartphone applications must be kept apart [54]. There are a number of guiding principles that protect people’s fundamental rights and guarantee that their information remains private and secret [45]. In order for governments to defend this course of action as moral, it is essential that the advantages enjoyed by the application users who divulge personal information outweigh any potential harm that could put the infected and their contacts in danger [80]. In order to battle and defeat the COVID-19 virus, the general population needs to experience these advantages and see them mirrored in society at large [17]. These applications ought to be designed to safeguard public health from the pandemic [81].

2.7. Unified Theory of Acceptance and Use of Technology

For assessing the adoption and usage of new technologies, the unified theory of acceptance and use of technology (UTAUT) has gained popularity [82]. This is the model put forth in “User Acceptance of Information Technology: Toward a Unified View” [83] by Venkatesh and colleagues. It is made up of four structures that are anticipated to influence the desire to utilize a specific technology [84]. These constructs—(1) performance expectancy, (2) effort expectancy, (3) social influence, and (4) facilitating conditions—are the fundamental building blocks of this theory [77]. While the fourth is a predictor of user behavior, the first three are direct predictors of usage intent and behavior [76]. Gender, age, experience, and voluntarism of use are assumed to be moderators of the four main components’ effects on usage purpose and behavior [85].

2.7.1. Performance Expectancy

The degree to which a person believes that using the apps would help him or her improve his or her job performance is known as performance expectancy [67]. He can use it to gauge how much these users aspire to the advantages they anticipate from adopting this technology [79]. The fundamental component of modern information systems and applications that ultimately defines their dependability and usability is performance expectancy [86]. Through variables such as perceived benefit, work suitability, internal and external motivation, comparative advantage, and expectations of outcomes from current technology, it is noticeably possible to determine the performance expectation [14]. In a nutshell, we predict that respondents will be more likely to install applications if they have high hopes for the performance of COVID-19 applications in aiding in the discovery of positive cases as well as regarding the contribution of these applications to halting the spread of the virus and responding to it.

2.7.2. Effort Expectancy

Effort expectancy is one of the components of the Unified Theory of Acceptance and Usage of Technology (UTAUT) model, which has received remarkable interest from many researchers in several areas of recent scientific research [85]. Effort expectancy is defined as a measure of the degree of ease an individual can expect when using COVID-19 applications [86]. It implicitly indicates the level of the individuals’ expectation that the use of COVID-19 apps will not be characterized by mental and physical efforts [64]. The effort forecast is based on the principle that there are links between the effort expended at work, the performance accomplished from that effort, and the gains received from that effort [19]. We assume that when individuals expect the application to be easier for them to use, they will be more inclined to do so and their download-ability of the application will be greater.

2.7.3. Facilitating Conditions

An individual’s confidence in the presence of a technological and organizational infrastructure to enable the usage of the app is referred to as one of the facilitating circumstances [80]. Additionally, this includes respondents’ opinions on the accessibility of non-public resources and assistance that they may rely on when utilizing the COVID-19 applications [12]. Facilitating circumstances are elements of a setting that permit people to utilize COVID-19 apps on cellphones [37]. Indicators such as perceived behavioral control and compatibility help characterize the facilitating environment [84]. The availability of organizational resources (materials and people) and the necessary technological infrastructure to attain peak performance are necessary for the efficient implementation of COVID-19 apps to help stop the pandemic from spreading [76]. This means that whether people actually use COVID-19 apps to combat the epidemic via mobile phones depends on how strongly they believe that organizational resources and technical infrastructure are in place to support the effective use of COVID-19 applications to stop the spread of the disease.

2.7.4. Social Influence

The extent to which people perceive that influential people expect them to use contemporary technology is referred to as social influence [84]. One of the fundamental building blocks of people’s early experiences with modern technology has been shown to be social impact [86]. Even if it does not play a crucial function, it eventually becomes superfluous as long as the technology is employed [83]. The continuing usage of technology by an individual is influenced more by their experience [76]. Therefore, based on our study into new applications, we anticipate that users will consider the COVID-19 apps vital and intend to download and use them if they think other VIPs will use them, support them, or advise them to do so.

2.7.5. Privacy Concerns

The adoption and acceptability of contact-tracking apps by people have received very little study as of the time of this study, particularly when taking into account the adoption and acceptance theories already in place for technology [86]. However, research indicates that privacy concerns are a crucial factor in people’s willingness to use contact tracing programs [35]. Given that privacy issues rise as government engagement grows, this privacy problem seems to be especially crucial in the setting of government involvement [1]. Since the government generally supports contact-tracing applications, privacy issues should be taken into account and researched as a potential influence on the decision to utilize COVID-19 apps [76].

Researchers have discovered some data that suggest the adoption of contact-tracking applications is influenced by privacy and cybersecurity concerns, as well as confidence in the suppliers of these apps [86]. These findings are the result of a large-scale, cross-country study. Prior research has shown that privacy issues around health informatics have a detrimental impact on how technology connected to patients’ health is used [20]. When applying UTAUT on the adoption of COVID-19 applications, credibility and transparency have been proposed by [53] as a means of addressing privacy issues.

3. Results and Discussion

Contact with persons who have COVID-19 virus symptoms and those who have been identified as carriers can spread the disease. The health of those living in red zones and places where the virus is present is being monitored [55] to offer crucial information on how to combat the outbreak. Numerous services are offered by contact-tracing applications, including the possibility for researchers to gather the data necessary for comprehensive analyses of the pandemic. Response times are slowed by the rather sluggish manual contact tracing. Applications for digital contact tracking aid in reducing the virus’s initial rate of propagation.

As with the rest of the world, Malaysia has been affected by the COVID-19 epidemic ever since it started [73]. To stop this outbreak, the Malaysian government deployed all of its resources. It was required that public knowledge be increased and the meaning of “public interest” defined in order to reduce this risk. “Universal peace, public rights, and welfare that are to be known, safeguarded, and promoted” are the definitions of “public interest” (Oxford English Dictionary). Because of its impact on the general populace and the disease’s propagation among society’s members, the COVID-19 virus might be viewed as a topic of public concern.

From all the reviewed works above, we notice that people are generally willing to help curb the spread of a disease by risking their privacy for others. One of the elements of the Unified Theory of Acceptance and Usage of Technology (UTAUT) model, which has drawn a lot of attention from scholars, is effort expectancy. We estimate that respondents who have high expectations for the performance of COVID-19 apps will be more inclined to install applications. In order to effectively apply COVID-19 applications and stop the epidemic from spreading, organizational resources (materials and personnel) and the required technology infrastructure must be available. Social influence is the degree to which individuals believe that powerful people expect them to adopt modern technologies. The social effect has been demonstrated to be one of the key tenets of people’s early interactions with contemporary technology.

People’s propensity to employ contact-tracking applications is heavily influenced by their worries about privacy. With government engagement, this privacy issue seems to be extremely important. Prior studies have demonstrated that privacy concerns in the context of health informatics have a negative effect on how technology related to patients’ health is employed.

4. Conclusions

This literature review looks into the acceptance model for using digital solutions to track the spread of COVID-19 and inform users early on of their level of exposure based on their proximity; it addresses various concerns the user might have about the application such as privacy and security, while outlining the different methods used for contact tracing by contrasting parties. Another factor affecting the adaptation of contact-tracing applications is whether the applications come from trusted parties; subsequently, most of the nationalized solutions are implemented by government parties, making them more trustworthy to most users. Most of the research on the acceptance model is ongoing; this survey focused on the acceptance model for COVID-19 digital contact-tracing apps in healthcare. In such recent works, most model-analysis research in healthcare has found that users are willing to utilize such applications to curb the spread of the disease.