Table 4 presents demographic characteristics of the study sample (n = 89). Among all participants across the 12 focus groups, nearly 60% identified as female, 38% as male, and 2% as other. Participants across all focus groups were aged 25 to 77 years. When asked to self-identify their ethnic background, 63% of all participants identified themselves as non-Hispanic Black or African American, 24% as Latinx/Hispanic, 2% as Asian American/Asian, and 8% as other. The majority of participants earned below $40,000 per year: 72% of participants reported their annual income was $30,000 to $40,000 and 17% reported their annual income was less than $30,000. Of the rest, 3% reported an annual income between $50,000 and $60,000, and 7% reported an annual income of more than $60,000.
Beliefs About Contact Tracing: Challenges and Opportunities
Contact tracing was understood by participants in the abstract but few had firsthand experience or deeper understanding about what it is, how it works, and who it might help. At the time of the focus groups in June 2020, no one recalled knowing anyone who had participated in COVID-19 contact tracing, and few recalled seeing or hearing communication on mass media about it. For older respondents, memories of contact tracing during the height of the HIV epidemic in the U.S. shaped their current understanding of the endeavor. Younger respondents perceived it as being linked to technology, such as a GPS-like system that digitally tracks people on their phones and sends alerts when they are close to someone with COVID-19. One participant said:
“It has to do with, like, GPS tracking, like with your phone and your computer, or something like that, something that’s a little bit more technological to it to see literally where you’ve been and who you were in contact with.” (Philadelphia; African American, Latinx/Hispanic, and Other Ethnicity).Footnote 2
One of the most common themes from the open discussion about contact tracing was a general sense of mistrust, fear and suspicion:
“It causes fear…it’s the same thing as if somebody called you in the police precinct saying, ‘Come here, we want to talk to you.’ It’s like the same thing…” (New York City; Latinx/Hispanic).
Concern about possible surveillance, coercion, and privacy infringement permeated the conversation about contact tracing, with many participants wondering where the information collected by a contact tracer would go, with whom it would be shared, and how it would be used:
“I understand they’re trying to get an understanding of the spread and find out people who have it, but I just don’t understand who’s using the information, who’s not using it, and what are they using it for besides obviously COVID.” (New York City; African American).
In particular, participants expressed skepticism with contact tracers because of their link with the government:
“I’m very distrustful at this time of the government and what they’re going to do with information and data.” (Philadelphia; African American, Latinx/Hispanic)
There were also fears that the information gathered by contact tracers could be used to report information to immigration agencies, deny insurance or unemployment benefits or to take away civil liberties:
“I don’t know anybody who would trust that information won’t be shared with immigration agencies because I don’t know that anybody trusts the government much at this point.” (New York City and Philadelphia; African American, Latinx/Hispanic, and White Caucasian).
Similarly, participants expressed concern about talking to strangers (especially when sensitive medical information is being shared), and said they might not answer a call if they don’t recognize the caller ID:
“I don’t answer phone calls of people I don’t know. I’d just think it’s a telemarketer or a bill collector.” (New York City, African American)
Furthermore, there was a shared concern that contact tracing is about “snitching,” and that participation could stigmatize those who have COVID-19 and possibly expose them to social ostracization.
Yet, despite these concerns, participants said they would, under the right conditions, participate in contact tracing because they would want to play their part to help control COVID-19 for their families and community:
“I would talk to contact tracers to help my community and make people aware.” (New York City; African American and Black)
Finally, discussions revealed that Latinx/Hispanic participants had faith in institutional authority and trust in local government:
“We have to believe our governor and mayor [of New York].” (New York City; Latinx/Hispanic)
For further categorization of beliefs about contact tracing by the themes identified, please refer to Table 5.
Ratings of Concepts
Across groups, participants rated “Be the One” as the top concept with 45% of total first-place votes in the online poll, followed by 30% for “Spread Love,” and 25% for “Keep in Contact.”
In individual polls (see Fig. 1), “Be the One” received the most positive reactions. 79% of participants reported that “Be the One” caught their attention, followed by “Keep in Contact” (76%) and “Spread Love” (73%). 71% of participants reported the concept “Be the One” motivated them to talk to contact tracers, compared with 66% and 64% of participants for concepts “Keep in Contact” and “Spread Love,” respectively. 78% of participants reported they would talk to others about contact tracing after seeing the concept “Spread Love,” followed by “Be the One” (77%) and “Keep in Contact” (67%).
In the comparative polls (see Fig. 2), while participants rated “Spread Love” as the most eye-catching (38%), they rated “Be the One” as the best concept for the other parameters of appeal, including most likely to motivate them to talk to and engage with contact tracers (51%) and make them talk to others about contact tracing (45%), and gives the best understanding of the benefits of participating in contact tracing (51%).
Discussions About the Concepts
Table 3 presents examples of quotes for the concepts and themes discussed below.
“Keep in Contact”
Overall, participants said the concept was not very memorable or attention-grabbing. The concept’s emphasis on human and family connection may have eclipsed the message about contact tracing: some participants missed the entire message about contact tracing. While the concept encouraged engagement with contact tracing and discussion with others, many felt that participation in contact tracing was the secondary, and not primary, message.
For this concept, participants were able to draw the connection between the benefit of keeping in contact with loved ones and the action of speaking to a contact tracer. However, across groups, participants noted how there was not enough information within the concept to promote or explain what contact tracing was or to answer their questions about COVID-19.
Participants agreed that the concept sparks conversation but not about contact tracing. The concept’s emphasis on community and family motivated participants to have the intention to work with contact tracers and other public health officials so that they can keep their families and friends healthy and safe from COVID-19.
Overall, participants found the concept relatable with the imagery reflective of their own experiences dealing with COVID-19 quarantine. The positive community and family-centered imagery, with people that look like their neighbors and families, resonated with participants.
The concept was consistent with the values shared by participants of the importance of community and staying in touch with family and friends.
Participants found the concept to be catchy with an easy-to-remember tagline. Participants also had positive reactions to the concept’s images and color presentation.
Overall, participants felt that the concept did not provide enough information about COVID-19 and contact tracing. In the current pandemic climate, where most people are taking actions to avoid spreading the disease, for many participants the word “spread” seemed confusing and counterintuitive. Some participants had positive reactions to the concept’s tagline, recognizing the play on words and noting how “spreading” could be turned into a positive. However, many participants said the concept did not successfully connect the benefit of contact tracing and the desired outcome of stopping the spread of COVID-19.
The concept motivated some participants to consider whether they knew anyone personally who could be a good contact tracer. However, many participants felt the concept did not provide a strong incentive to communicate with contact tracers. Many participants felt that the concept needed a stronger call to action and more specific information in order to motivate the viewer into action.
Participants connected with the concept and found its imagery relatable. In particular, the concept gave a local feeling because it depicted people that look like people in their community. In addition, participants connected with the concept because the messaging was rooted in the familiarity of their urban communities, such as Philadelphia is known as the city of brotherly love.
Participants noted that the concept was culturally diverse and shows different demographics. However, participants were divided on how the concept communicated protection and confidentiality of personal information, which is a value shared by participants. Some found it comforting to know that their personal information would be protected. In particular, the concept’s emphasis on personal information remaining confidential made participants feel more comfortable being called by a contact tracer. On the other hand, the concept did not succeed in overcoming the mistrust that some participants had about communicating with an official agency or government-related official.
“Be the One”
The direct, active, and engaging tone of the concept was well received by the majority of participants. Participants felt the concept had a sense of urgency that was missing from the other concepts.
Participants generally found that the concept provided more information about contact tracing than other concepts. However, when the concept was first introduced, some participants were confused about the concept’s priority audience as they thought it might be a possible recruitment message to hire people to be contact tracers.
Participants noted that the encouraging and positive messaging of this concept motivated them to speak with contact tracers. They felt that the concept spoke to the self-reliance that they have embraced during the pandemic, encouraging them to take ownership and action and be part of the solution. For other participants, the positive wording and hopeful imagery motivated them to talk with others about contact tracing and eased the perception that participating in contact tracing would be “snitching” on their community or opening themselves up to social ostracization.
Several participants experienced a personal connection to this concept, perceiving it as communicating the consequences of COVID-19 for their own lives. These participants felt it best captures the seriousness of the pandemic, the immediate need to take action to help stop its spread, and the appropriate tone with which to discuss the issues. In addition, many participants said the concept made them feel like a hero and gave them a sense of duty. Participants expressed that “being the one” can help people feel as if they are doing something useful for their community during this time when so many people feel helpless.
Despite participants being generally distrustful of the government and having concerns about contact tracing, they said this concept helped to motivate them to participate in contact tracing because it shows they can “be the one” to help reduce the spread of COVID-19 and save lives. The concept seemed to help mitigate participants’ concerns by framing them as the hero and part of the solution, linking the action of participation in contact tracing to the benefit of doing what is needed to prevent the spread of COVID-19 and save lives in their community. However, some participants said the concept could be potentially offensive because it specifically and exclusively targeted certain racial and ethnic groups.
General Reactions to The Concepts
Overall, participants saw exposure to the idea of contact tracing through the ad concepts as a step in the right direction, starting a conversation that had not been happening previously and encouraging participation that might benefit them and their communities:
“I feel a lot of people aren't familiar with the term [contact tracing] and don't realize how important it really is for them and their communities.” (New York City; African American).
However, while the concepts increased awareness of contact tracing, there was a feeling that some concepts lacked basic and crucial information about COVID-19 and failed to address key practicalities about how contact tracing will work:
“It might be helpful to explain what a contact tracer is for those who may not know.” (Philadelphia; African American, Latinx/Hispanic)
In addition, imagery across concepts, while relatable and inclusive of those who live in their communities, was seen as “too targeted” because they only showed Black and Brown faces, which to some respondents wrongly suggested that people in communities of color were more responsible for the spread of the virus:
“[The campaign] seemed to target a specific demographic as far as race and economic status as if they're the only ones infecting others.”(Philadelphia; African American, Latinx/Hispanic, and Other Ethnicity).
On the other hand, creative executions for each concept that featured local cues (such as local sports teams or personalities) increased relevance with participants, who felt the hometown references customized the concepts to speak directly to them:
“I like how it seems to focus on the brotherly love/sisterly affection theme for Philadelphia.” (Philadelphia; African American)
Overall, after seeing the concepts, many participants saw the benefits of contact tracing and were open to participation:
“Yes [this campaign motivated me to talk to and engage with contact tracers…it helps the community we are from to be cared for and protected.” (New York City; Latinx/Hispanic)