5 minute read 2 Nov 2020
Young man and woman social distancing on a bench using phones

How design can increase adoption of COVID-19 exposure notification apps

By Rob Tannen

User Experience Psychologist, EY Design Studio

Human-centered researcher. Design essayist. Patent aficionado. FIFA gamer.

5 minute read 2 Nov 2020

Human-centered experience design can help reduce barriers to the usage of exposure notification apps.

In brief
  • Lack of awareness, trust and understanding impact the use of COVID-19 exposure notification apps.
  • User-centered design methods can identify and proactively address issues of understanding and usability.
  • Ongoing user feedback is essential to adapt and improve these apps as conditions and perceptions change over time.

In an effort to lessen the spread of COVID-19, traditional contact tracing efforts are being complemented by new smartphone-based solutions, which offer greater efficiency and privacy. Exposure notification apps typically utilize anonymous phone-to-phone signals to determine exposure, based on the duration and proximity of contact between devices. If a person subsequently reports a positive COVID-19 test, others who had been in proximity can be alerted to a potential exposure.

Numerous countries and regions have launched such apps, which, like wearing a mask, can provide community health benefits with relatively little effort. But as with face coverings, enough people need to use the apps to achieve effectiveness.

Not surprisingly, there are some concerns and resistance to using these novel technologies, particularly as they may function in unfamiliar ways. For example, measuring proximity without the use of GPS (i.e., relying on Bluetooth signal strength), or for the majority of users, offering no routine need to access the app at all following installation. Such characteristics can challenge expectations for users and app designers alike.

User Experience Challenges

Exposure notification apps present a series of seemingly contradictory interactions that must be effectively addressed to create understandable and easy-to-use experiences for end-users.

1. Publicize Anonymity

Many people lack trust in government and/or technology companies handling personal data, particularly for health-related information. Exposure notification apps sit at the convergence of these concerns. Add to that the common misperception that these apps determine proximity via GPS, thereby allowing location tracking, and the result is a perfect storm of security and privacy concerns. In fact, most of these apps do not capture any personally identifiable information about the user and utilize near-field signals (e.g., Bluetooth), rather than location-based (e.g., GPS), to determine proximity.

Given these misapprehensions, it is an uphill battle getting people to understand and download an exposure notification app, let alone achieve widespread usage. Therefore, it is essential to invest in omnichannel educational marketing toward aligning expectations. Ironically, it may be the people you know and trust who can be most persuasive in communicating the anonymity of the apps.

Once potential users are willing to download the app, education needs to continue within the app itself, particularly in the initial onboarding process. Apps should provide upfront and simple explanations of how the exposure reporting and notification processes work, reinforcing user anonymity and providing access to greater detail on the technology, as desired.

2. Make the Unused Usable

Designers must create an app that users may hope to never interact with. Once downloaded, exposure notifications apps are largely “set and forget” and can typically function without user involvement. In fact, the only times users may need to access the app is if they receive notification of an exposure or need to report a positive test result themselves – both highly rare circumstances, fortunately.

The downside to this very limited user engagement is that when the app is finally used, it can essentially be a first-time experience. Lack of recency or familiarity can impact usability, with understanding of previously used features and terminology diminishing over time. Moreover, the trigger for accessing the app is stressful news itself, so clarity and simplicity of the user experience are critical.

Key recommendations for achieving usable exposure notification apps include:

  • Providing clear feedback that the app is functioning, and if not, how to make it work
  • Allowing users to review instructional onboarding information at any point to refresh their understanding when it is needed most
  • Continuing to reinforce anonymity throughout the usage lifecycle
  • Increasing app engagement by including anonymous reference data, such as regional trends

In many cases, the quick development of exposure notification apps resulted in quick launches with limited functionality, followed by update releases. Consequently, a user is likely to face new features, design elements, and content when returning to use the app even after a few weeks. It is recommended that significant enhancement and changes are communicated contextually through the app.

The best way to establish effective experience design is through ongoing user feedback methods, such as usability testing. This is especially critical given the perception and usability challenges of exposure notification apps. Focusing research on participants who are most likely to be exposed to COVID-19, such as frontline and essential workers, can provide critical real-world feedback for improving these apps.

3. Notify Confidentially

Ultimately, these notification apps provide value by alerting people that they may have been recently exposed so they can proactively quarantine and potentially get tested. It’s one thing to get a smartphone notification about an appointment or a sports score, but it’s a very different situation when communicating about possible exposure to a life-threatening virus.

Given that these apps require minimal direct interaction, the notification feature may be the most important element of the user-experience. Like any app-based notification, users do have the option of de-activating them, meaning a highly important alert may not be received. Therefore, the set-up process should strongly emphasize the value of notifications and the consequence of declining them.

From a messaging perspective, notifications must be delivered in a sensitive and actionable way. Due to confidentiality concerns, the wording of a notification needs to land between being broad enough as to not reveal confidential health information to others who might see the alert, and being specific enough to indicate urgency.

Next Steps

The success of exposure notification apps in reducing and controlling the spread of COVID-19 depends on several factors, including awareness, understanding. and usability. All of these come into play when designing the user-experience of these apps and present unique opportunities to designers.

As more of these apps are launched and gain traction, public perceptions and concerns with these technologies may shift, but there will always be opportunities for improvement. Effectively gathering and integrating users’ understanding and experiences with these apps will lead to their ongoing development as a tool against the virus and future community health challenges.

A promising evolution of these apps would be to serve as a "one-stop-shop" for coordinating virus detection, treatment, and, ultimately, prevention. Providing a consolidated tool for exposure notification, test scheduling, and even vaccine delivery coordination could prove a worthwhile user-experience design challenge.

Summary

The COVID-19 pandemic has led to the development of apps that challenges conventions of interaction design. Recognizing and addressing these via user-centered methods can support near-term adoption and inform the long-term design of future digital health tools.

About this article

By Rob Tannen

User Experience Psychologist, EY Design Studio

Human-centered researcher. Design essayist. Patent aficionado. FIFA gamer.