Coronavirus: NZ COVID Tracer app, messaging from health officials need an overhaul - software developer

It's over. Having racked up nine days without a community case, another coronavirus scare has successfully been contained without ballooning into a full-blown outbreak.

We're safe again, for now.

Health officials are continuing their catch-cry to 'scan, scan, scan' but they're mostly falling on deaf ears. Rates of usage for the NZ COVID Tracer app are already falling.

As they always do, until the next outbreak.

Then Kiwis, galvanised by our mutual fear of catching the virus, will remember what health officials had been saying all along. The app will see a brief renaissance until the danger clears once more and we lose interest.

It seems bizarre that this is the pattern that occurs when the app's so easy to use - after all, all you have to do is open your phone, find the COVID Tracer app, take a photo of the QR code and you're done.

But what if Kiwis have never been shown how to use the app? What if the motivations for using it are all wrong? What if the rewards for using it regularly are too meager, or we've become numb to accusations of complacency by health officials?

These are the types of questions being posed by software developer Radhika Reddy, who is calling on the Ministry of Health to do a deep-dive into the reasons behind New Zealand's poor QR code scanning rates.

Reddy says they're a "cause for concern", and wants them to be covered in a rapid audit similar to the one commissioned by infectious diseases expert Dr Ayesha Verrall last May, before the COVID Tracer app was launched.

Even without such a report, Reddy is brimming with ideas on how to improve the system - she has even been asked to speak with the Ministry of Health about them - but she wants it to start with the messaging from those at the top.

'It's unfair to put the burden on users'

COVID-19 Response Minister Chris Hipkins and Director-General of Health Dr Ashley Bloomfield are often heard issuing directives to keep scanning, to take precautions, to not get complacent.

The Ministry of Health's recent 'Make Summer Unstoppable' campaign echoed these sentiments, urging Kiwis to scan QR codes, turn on bluetooth tracing, stay home when sick and wash hands to ensure a hiccup-less holiday season.

But the marketing didn't have the desired effect, at least in regard to QR scans.

Ministry of Health figures show COVID Tracer app QR scans had dipped to 520,611 by January 24, the day before a woman tested positive for coronavirus in Northland. Two days later, they'd more than doubled to 1.07 million.

Reddy says it's unfair for the responsibility to fall solely on the shoulders of app users, and thinks the app itself could be improved to make using it a simpler experience.

"[That messaging] shifts the burden onto the user as if we're the ones who are being complacent, when in fact I think there's a lot more room for improvement with the app," he said.

"Without that kind of support built into the system and the communications around it, it's a bit unfair to turn the burden on users and say 'we built this thing that isn't very good at those aspects, and make up the gaps by yourself'.

"It's that kind of personal responsibility approach that I think, as a systems builder, doesn't work."

On top of failing to convince Kiwis to scan more, Reddy says these pleas are predicated on Kiwis being fearful of a full-blown community outbreak - a fear that dissipates the longer we go without community cases.

"We need people to be scanning before an outbreak, not once the outbreak happens. It's good that they scan after the outbreak, but we really need people to be scanning much before that so that we can protect that possibility of an outbreak occurring," Reddy said.

"When the Director-General says things like 'we should not be complacent', that's an attribution to motivation of a certain kind that's usually motivated by fear.

"We've seen that after an outbreak, people develop a sense of temporary fear and react by using the app in larger numbers... That is a reliance on fear being a motivator, which is unreliable over time."

Kiwis 'need help' to make QR scanning second nature

Reddy says the COVID Tracer app scanning process is often unclear - a fact most recently exposed by the amusing but perhaps rather concerning anecdote of a Kiwi grandfather who thought he had been scanning QR codes for months, but had actually just been taking photos of them.

She suggests health officials implement a three-step process that helps form the habit of scanning and gives us all the know-how and confidence to use it regularly.

These steps are:

  • Recognising the cue to scan: Ensuring comms are clear on what QR codes are, and instructing us to look out for them.

  • Taking a moment to scan: Encouraging Kiwis to pause for a moment, take out their phone, open the app and scan the QR code.

  • Offering a reward: Sealing the behaviour in by providing some sort of encouragement in the form of a complimentary message on the app - "ka pai, you're helping to save time contact tracing!" - or from health officials.

While Reddy concedes this makes the process more long-winded, she believes the fact it's specific and targeted means ultimately it will take less mental effort for non-regular COVID Tracer app users to start scanning than the current message of "scan, scan, scan".

"Most of us agree we should use the app a lot, but we need help and guidance from the system to help us do that better," she told Newshub.

"That third step, to give yourself some sort of positive reinforcement, is really important - a compliment, a pat on the back, a little high-five or whatever. If you're happy you're contributing to a higher purpose, people can repeat the behaviour over and over and it'll form a habit."

Another issue, Reddy says, is that health officials are overly reliant on members of the public showing each other how to use the app, making the habit-forming process more difficult.

While it's easy to remember to scan when COVID-19 is spreading like wildfire through the community, forming the habit when the virus is contained to managed isolation and quarantine (MIQ) facilities takes a little more discipline.

Ideally, QR poster scanning would be so frequent and visible that we could rely on seeing others do it as a cue to do it ourselves. But Reddy says this doesn't work.

"We have an instinct as humans to mimic what other people are doing. [But] if the reliance is on seeing someone doing it in public, that's not a very good approach, because as most people who scan will tell you, it only takes them a couple of seconds," she explained.

"If you're relying on me spotting someone doing something in a couple of seconds, that's not going to happen, right? Loads of people pick their noses in public, but I'm not going to notice that every time.

"Those people will be scanning, but I won't notice as much as they're really doing it, so I'll get the impression maybe nobody's scanning."

The Ministry of Health needs to be more demonstrative in showing Kiwis how to use the COVID Tracer app, Reddy says.

"Every poster should come with three panels of instructions showing someone actually scanning - sort of like an aeroplane safety card. The poster should have the logo of the icon you have to press on the app to make the visual association clearer. The fact that it doesn't, I think, is a communication problem," she said.

"These are the sorts of things that are missing at the moment in the system, and I think before we turn to users and say 'hey it's your fault, you're being complacent, you need to do something', we should make sure these things are aligned.

"We should do a systemic review of all the gaps in the behavioural design and the communications and the app, then we can turn to users and say 'if you're still not using it, it's kind of your fault'. But the best efforts have to be made by the system builders and ministry and Unite Against COVID-19 first."

Ministry of Health 'receptive' to app feedback

While QR code scanning rates dipped over the Christmas holidays despite the 'Make Summer Unstoppable' campaign, the Ministry of Health is pleased with the uptake in bluetooth tracing.

After starting on 351,430 bluetooth activations when the feature was launched on December 18, this figure increased steadily to 605,751 by January 24 before jumping sharply to 859,369 activations a day when the Northland case was announced.

By the end of this week, more than 930,000 Kiwis had activated bluetooth on the app.

Shayne Hunter, the Ministry of Health's Deputy Director-General of Data and Digital, says encouraging people to download the app, scan QR codes and turn on bluetooth tracing were key parts of the 'Make Summer Unstoppable' campaign.

He told Newshub health officials have seen "good success" as a result of the emphasis on these actions.

However the Ministry of Health isn't resting on its laurels. Hunter says it commissioned behavioural research at the end of 2020 and implemented recommendations based on the findings. It's also discussed other recommendations with Unite Against COVID-19.

"The research findings are informing our upcoming improvements to the NZ COVID Tracer app, messaging, and campaigns. We are also going to use feedback we have had from other experts that we have communicated with," he said.

Reddy is one of these experts, and has been invited to speak to the Ministry of Health about her ideas to improve the app on two occasions.

She says they've been "very open and receptive" to her comments, but wants them to look into commissioning another report on the app and its messaging.

"Given the [Verrall] report was made before the smartphone app was developed, I think it's time for a follow-up that does a system review across health, across COVID-19, all those different routes in Government that have a hand in this, to see why they're not aligned," she said.

"To see why the messaging on the bus shelter ad doesn't reinforce the messaging on the poster, which doesn't reinforce the messaging on the app - that's the kind of report I think we're due for now, given the performance of scanning rate.

"I don't think that was a KPI [Key Performance Indicator] in the Verrall report, but it's the sort of thing that should now be cause for concern. It's time for a systemic review, a blue-ribbon panel to do a rapid audit similar to what was done a few months ago."

There's no sign of whether that's forthcoming, but Hunter says the Ministry of Health is always looking at ways to improve.

"Our messaging is already evolving and we're making best efforts to explain the reason for scanning and the value of the NZ COVID Tracer app in speeding up contact tracing," he said.