The Influence of Normative Perceptions on the Uptake of the COVID-19 TraceTogether Digital Contact Tracing System: Cross-sectional Study

Lee, Jeong Kyu; Lin, Lavinia; Kang, Hyunjin

BACKGROUND: In 2020, the Singapore government rolled out the TraceTogether (TT) Programme, a digital system to facilitate contact tracing efforts in response to the COVID-19 pandemic. This system is available as a smartphone app and Bluetooth-enabled token to help identify close contacts. As of February 1 2021, more than 80% of the population have either downloaded the mobile app or received the token in Singapore. Despite the high adoption rate of the TT mobile app and token (i.e. device), it is crucial to understand the role of social and normative perceptions in the uptake and usage by the public, given that the collective efforts for contact tracing. OBJECTIVE: This study aimed to examine the normative influences (descriptive and injunctive norms) on the TT device use for contact tracing purposes, informed by the Theory of Normative Social Behavior (TNSB), a theoretical framework to explain how perceived social norms are related to behaviors. METHODS: From January to February 2021, cross-sectional data were collected by a local research company through emailing their panel members who were: 1) Singapore citizens or permanent residents aged 21 years and above; 2) able to read English; and 3) Internet users with access to a personal email account. The study sample (n = 1,137) was restricted to those who had either downloaded the TT mobile app or received the token. RESULTS: Multivariate (linear and ordinal logistic) regression analyses were carried out to assess the relationships of the behavioral outcome variables (TT device usage and intention of TT device usage) to potential correlates including perceived social norms, perceived community and interpersonal communication. Multivariate regression analyses indicated that descriptive norms (unstandardized regression coefficient, ß = 0.31, SE = 0.29, p < .001) and injunctive norms (ß = 0.16, SE = 0.16, p < .001) were significantly, positively associated with intention to use TT device. It was also found that descriptive norms were a significant correlate of TT device use frequency (adjusted odds ratio, OR = 2.08, 95% CI: 1.66 - 2.61, p < .001). Though not significantly related to TT device use frequency, injunctive norms moderated the relationship between descriptive norms and the outcome variable (OR = 1.12, 95% CI: 1.03 - 1.21, p = .005). CONCLUSIONS: This study provides useful implications for the design of effective intervention strategies to promote the uptake and usage of the digital methods for contact tracing in a multi-ethnic Asian population. Our findings highlight that influence from social networks plays an important role in developing normative perceptions in relation to TT device use for contact tracing. To promote the uptake of TT device and other preventive behaviors for COVID-19, it would be useful to devise norm-based interventions that address these normative perceptions by presenting high prevalence and approval of important social referents, such as family and close friends.