Widening or narrowing inequalities? The equity implications of digital tools to support COVID-19 contact tracing: a qualitative study

O'Donnell, C. A. , Macdonald, S. , Browne, S. , Albanese, A., Blane, D. , Ibbotson, T. , Laidlaw, L., Heaney, D. and Lowe, D. J. (2022) Widening or narrowing inequalities? The equity implications of digital tools to support COVID-19 contact tracing: a qualitative study. Health Expectations, 25(6), pp. 2851-2861. (doi: 10.1111/hex.13593) (PMID:36063060) (PMCID:PMC9538145)

Abstract

Background: As digital tools are increasingly used to support COVID-19 contact tracing, the equity implications must be considered. As part of a study to understand the public's views of digital contact tracing tools developed for the national ‘Test and Protect’ programme in Scotland, we aimed to explore the views of groups often excluded from such discussions. This paper reports on their views about the potential for contact tracing to exacerbate inequalities. Methods: A qualitative study was carried out; interviews were conducted with key informants from organizations supporting people in marginalized situations, followed by interviews and focus groups with people recruited from these groups. Participants included, or represented, minority ethnic groups, asylum seekers and refugees and those experiencing multiple disadvantage including severe and enduring poverty. Results: A total of 42 people participated: 13 key informants and 29 members of the public. While public participants were supportive of contact tracing, key informants raised concerns. Both sets of participants spoke about how contact tracing, and its associated digital tools, might increase inequalities. Barriers included finances (inability to afford smartphones or the data to ensure access to the internet); language (digital tools were available only in English and required a degree of literacy, even for English speakers); and trust (many marginalized groups distrusted statutory organizations and there were concerns that data may be passed to other organizations). One strength was that NHS Scotland, the data guardian, is seen as a generally trustworthy organization. Poverty was recognized as a barrier to people's ability to self-isolate. Some participants were concerned about giving contact details of individuals who might struggle to self-isolate for financial reasons. Conclusions: The impact of contact tracing and associated digital tools on marginalized populations needs careful monitoring. This should include the contact tracing process and the ability of people to self-isolate. Regular clear messaging from trusted groups and community members could help maintain trust and participation in the programme. Patient and Public Contribution: Our patient and public involvement coapplicant, L. L., was involved in all aspects of the study including coauthorship. Interim results were presented to our local Public and Patient Involvement and Engagement Group, who commented on interpretation and made suggestions about further recruitment.

• Item Type: Articles
• Additional Information: This study was supported by the Scottish Government through the Digital Health & Care Innovation Centre.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Blane, Dr David and Browne, Dr Susan and Ibbotson, Dr Tracy and Laidlaw, Mrs Lynn and Lowe, Dr David and Albanese, Alessio and O'Donnell, Professor Kate and Macdonald, Professor Sara
• Authors: O'Donnell, C. A., Macdonald, S., Browne, S., Albanese, A., Blane, D., Ibbotson, T., Laidlaw, L., Heaney, D., and Lowe, D. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Health Expectations
• Publisher: Wiley
• ISSN: 1369-6513
• ISSN (Online): 1369-7625
• Published Online: 05 September 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in Health Expectations 25(6): 2851-2861
• Publisher Policy: Reproduced under a Creative Commons License