Introduction: The Rise of Digital Public Health Tools
Digital health tools surged during the COVID-19 era, accelerating the shift toward electronic records, telemedicine, and digital vaccination verification. Washington State’s WA Verify, built on the SMART Health Card framework, became a widely used method for sharing vaccination status via mobile devices. As public health systems increasingly rely on these tools, understanding how residents perceive, trust, and adopt them is essential for effective design and equitable rollout.
The TAM Framework and the WA Verify Survey
This analysis draws on the Technology Acceptance Model (TAM), which posits that perceived usefulness and perceived ease of use shape attitudes toward a health technology and, in turn, adoption. External factors—such as privacy concerns, design features, and social influences—also influence usefulness and ease of use. The WA Verify Statewide Survey applied this lens to examine what facilitates or hinders acceptance of a verifiable health information (VCI) tool among Washington residents.
Methods in Brief
Researchers conducted a statewide, multimodal survey (n = 1491 completed; 1401 included in analysis) drawn from a random sample of 5,000 households. The instrument covered technology access, VCI experience, beliefs about digital health tools, and sociodemographics. Responses were weighted to reflect Washington’s population across race/ethnicity, age, and sex. Respondents were categorized into three groups: users (already using WA Verify or similar tools), potential users (not using WA Verify but willing to use a portable electronic vaccine record), and unlikely users (not using WA Verify and not willing to use such a tool).
Key Findings: Who Uses, Who Might Use, and Who Isn’t Ready
Poststratified weights placed the groups at roughly 26% users, 50% potential users, and 24% unlikely users. Across all groups, support for policies requiring vaccination proof or negative tests varied dramatically by willingness to use the tool: users and potential users showed strong backing, while unlikely users leaned toward opposition.
Reasons to Use WA Verify
- Converting vaccination cards to a phone format was highly appealing for both users (96.5%) and potential users (92.3%).
- Speeding up check-ins and access to healthcare facilities resonated with 76.2% of adopters and 69.5% of potential users.
- Many cited a preference for new technologies (65.0% of users; 53.8% of potential users).
- Felt a tool like WA Verify helps protect the community (66.6% of users; 61.8% of potential users).
Reasons Not to Use WA Verify
- Privacy and security fears dominated concerns among unlikely users: data security (65.7%), worries about hacking (40.4%), and distrust that public health authorities should access data (63.4% of unlikely users).
- Practical barriers also mattered: not carrying a phone (36% among unlikely users vs. ~10% in other groups), and perceived difficulty adding the tool to a phone (21.2%).
- A sizable share of unlikely users reported no personal benefit in using the tool (63.1%).
Information Channels and Tech Readiness
Across groups, health care providers were the most trusted information source for WA Verify, followed by COVID-19 vaccination appointments and news coverage. Yet, only about one-third of unlikely users selected any of the listed channels, highlighting the challenge of reaching this group. In terms of tech readiness, 12.3% of users were classified as lower tech readiness, versus 15.9% of potential users and 32.3% of unlikely users. Notably, 13% of unlikely users did not own a smartphone, underscoring the digital divide.
Interpretation: What Drives Acceptance and What Hinders It
The findings illustrate that acceptance of digital public health tools hinges on perceived usefulness and ease of use, but external concerns—especially privacy and trust—can override convenience. Even among those who use or intend to use WA Verify, privacy worries about data handling, tracking, and government access persist. The analysis also reveals a digital divide: older adults, those without smartphones, and individuals with lower tech readiness are less likely to adopt such tools, raising equity concerns for digital health initiatives.
Implications for Public Health Strategy
Public health campaigns should emphasize transparent data protections, minimal data collection, and robust security measures to build trust. Providing nondigital alternatives and targeted education for groups with lower tech readiness can help avoid widening health disparities. Information campaigns leveraging trusted sources like healthcare providers, vaccine appointments, and community settings can broaden reach, while multilingual and accessible materials reduce language and literacy barriers. The WA Verify experience also offers lessons for future digital public health tools, including clear value propositions, user-centric design, and continuous monitoring of privacy concerns.
Limitations and Future Directions
As a cross-sectional, self-reported survey within Washington State, findings may not generalize to other regions. Response bias and nonresponse remain considerations, though weighting mitigates some biases. Future work should explore longitudinal changes, deeper qualitative insights into distrust, and strategies to increase adoption among those who remain unlikely to engage with digital health verification tools. The evolution of digital health platforms—such as broader health information sharing with secure standards—offers opportunities to apply these lessons to new tools while safeguarding equity and trust.
Conclusion
The WA Verify survey illuminates the spectrum of attitudes toward digital public health tools. While a majority are open to adoption or already using such technologies, privacy concerns and tech readiness emerge as key barriers, especially among unlikely users. Addressing these concerns through transparent design, inclusive outreach, and accessible alternatives will be essential for future public health informatics initiatives and the equitable use of digital health tools.
