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Protective Behaviors Following Digital COVID-19 Exposure Notifications, Washington State, September 1, 2021, to March
Nicole L Briggs1, Brandon L Guthrie, Adam S Elder
1Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington (Ms Briggs); Departments of Global Health and Epidemiology, School of Public Health, University of Washington, Seattle, Washington (Dr Guthrie); Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington (Dr Elder); Department of Health Systems and Population Health (Ms Revere), Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington (Ms Molino); Office of Innovation and Technology, Washington State Department of Health, Tumwater, Washington (Mss West and Higgins);Office of Innovation and Technology, Washington State Department of Health, Tumwater and Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington (Dr Karras); and Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington (Dr Baseman).
Context:
Digital exposure notification (EN) systems were widely used to supplement public health case investigations and contact tracing during the 2019 coronavirus disease (COVID-19) pandemic. In Washington State, the state Department of Health (DOH) implemented one such system, WA Notify, which generated ENs based on smartphone Bluetooth proximity detection. However, the privacy preserving measures of this technology prevented collection of information on how users responded after seeing an EN on their device.
Objective:
To understand the influence of ENs on intended and implemented protective behaviors among WA Notify users.
Design:
Two self-report surveys were administered by the WA DOH: a baseline survey regarding planned protective behaviors, available immediately after seeing an EN, and a follow-up survey distributed 2 weeks later regarding actual protective behaviors implemented. Self-reported planned and implemented protective behaviors were compared across 3 time periods relevant to the COVID-19 pandemic. Poisson regression was used to compare the probability of engaging in various protective behaviors across demographic characteristics and other contextual factors.
Setting:
Washington State.
Participants:
A total of 4280 individuals who chose to respond to both surveys and who completed the initial survey between September 1, 2021, and March 1, 2022.
Main Outcome Measures:
Self-reported plans for and engagement in protective behaviors (quarantining, testing, and symptom watching).
Results:
The proportion of individuals who reported implementing quarantining and symptom watching after seeing an EN was higher than the proportion that reported planning to engage in each respective behavior. Respondents who reported experiencing symptoms when seeing an EN were more likely to quarantine and test for COVID-19 compared to those with no symptoms.
Conclusion:
Plans to engage in protective behaviors after initially seeing an EN can change and may be influenced by evolving personal and contextual factors. Future digital EN systems can be improved through messaging tailored to encourage protective behaviors relevant to disease prevention.
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