Public Health Measure 1: Contact tracing	Study features	Outcomes and findings	Translational steps
Systematic reviews, guidelines
Chung 2021# Citation type: SR Public health measure: Contact tracing, and also, maps onto isolation and quarantine Mapping to: Uptake, adherence Mapping to: Theme 1: features of public communication: content, timing and duration, and delivery Theme 3: support for individual and population behavioural changes Theme 5: public trust and perceptions	Overview and aim: To examine experiences and approaches of countries implementing find, test, trace, isolate, support (FTTIS) strategies early in the COVID‐19 pandemic Type of study and data: SR; primarily qualitative; N = 118 included (e.g. rapid report/reviews, case study/series, evaluation/simulation studies, narrative reviews) Inclusion and exclusion criteria: Included: English language; published research studies/reviews of contact tracing, testing, isolation or quarantine Participant features and numbers, sampling details: Approaches of interest applied to general population; no specific selection criteria related to participants were stated or reported against. Included disease(s): COVID‐19 Timing: Searches run May 2019 to January 2021. No further consideration of timing, although authors noted that review focused on FTTIS measures early in the pandemic Countries included: Various, not systematically described (included South Korea, Japan, Taiwan, UK, USA, Portugal, Brazil, Bangladesh, India). Studies likely across all income brackets (low to high income) but not specifically identified. Intervention or phenomenon of interest: Communication to support contact tracing, adherence to isolation and subsequent public health actions Quality assessment: AMSTAR 4/11 [1. Not clear whether protocol was established a priori; 2. Unclear re duplicate screening/data extraction; 4. Seems published papers only, in English, included; 5. No excluded studies provided; 8. No integration of quality assessments; 10 no publication bias assessment; 11. No COI for included studies]. Funding source: DP is funded through the EPSRC I sense consortium, and other authors receive no funding for the study.	Data on testing and contact tracing approaches and infrastructure, test performance or digital contact tracing applications not extracted and reported as unrelated to communication Self‐isolation/quarantine: Features of support for those undertaking self‐isolation (note Webster 2020, Brooks 2020 papers already included in original review cited here, together with additional papers) Factors associated with adherence included knowledge of the disease and process for quarantine, social norms, perceived benefits of quarantine and risk of disease, and access to essential supplies and/or financial support. For informal or low‐income earners, self‐isolation or quarantine may be unaffordable, and people may require financial support to undertake the measures. Isolation or quarantine may have adverse psychological consequences (e.g. anxiety, confusion, anger and PTSD symptoms) and may be related to factors such as fear of infection and inadequate supplies. Increased rates of domestic violence have also been reported. Providing sufficient timely information to people undertaking isolation/quarantine may improve uncertainty, quarantining people for the minimum safe period, and ensuring provision of adequate supplies may mitigate these negative effects. Psychological screening may also help to identify those most in need of support (e.g. counselling, coaching, social prescribing such as exercise or art classes, online communication (e.g. via social media) may help reduce loneliness during & increase coping during isolation. Testing: Communicating information about how to get a test, and under what conditions, has been challenging. This is especially true for some minority ethnic groups. Public awareness and communication: Public perceptions of the reliability of testing services, and effectiveness of communication about actions that can be taken to help contain COVID‐19 both influence uptake. Testing kits and stations also need to be accessible to disadvantaged groups and, if such groups (e.g. ethnic minorities) are at heightened risk, then communication must be tailored to encourage engagement with testing. Communication by authorities to ensure the public are well‐informed and kept up to date about the pandemic as the situation changes is important for increasing awareness of the need for FTTIS and correcting misinformation or rumours that may arise where there is uncertainty or gaps in public knowledge. Regular press conferences by authorities (including progress briefings, policy changes & correcting misinformation) may have a role in such communication to provide clear information about disease risk severity. Social media and the Internet may also influence behaviour when people are in isolation. For instance, social media may increase intention to adhere to public health measures, whereas conspiracy beliefs can be inversely associated with adherence to self‐isolation guidelines. Lowering perceived response costs and clear information about the severity of risks may help motivate the public to self‐isolate. Reliable official sources (e.g. government information, official news and journalism) may be best placed to communicate information about severity of disease risk, while social media may best focus on messaging related to recommended health measures and messages of hope. Public co‐operation: Low public trust of government may prevent public cooperation with FTTI guidelines. Conversely, perceived benefits, self‐efficacy and trust are positively associated with uptake of contact tracing apps. To support uptake of contact tracing apps, personal information must be protected. This can help to promote trust, prioritise care and encourage individuals to cooperate with guidelines to prevent transmission of disease. Recommendations: Implementing an effective FTTIS system includes the need for support measures to promote testing and behaviours such as isolation or quarantine associated with testing. Support can include timely, adequate information to reduce anxiety and uncertainty, or practical supports in the form of provision of adequate supplies or financial assistance. Such measures also serve to build public trust, which is key to controlling COVID‐19 in any population as this relies on people voluntarily providing their information and following public health measures. Public communication by authorities is also critical to provide ongoing information about the pandemic and/or policies over time. An essential part of this is ensuring open and balanced discussions take place about concerns such as data privacy/protection, and limits on personal freedom for the greater societal good.	Communication purpose: Findings may inform communication strategies for increasing public awareness of the need for FTTIS, such as providing tailored, up‐to‐date information, practical and financial supports, and working to build trust amongst community members and the public more broadly. Related to review questions: Clear, reliable information, including that about disease risk severity and societal benefits of measures, may help to dispel distrust of government/authorities and promote uptake of testing and isolation behaviours required to control disease transmission. Communication of such information needs to be flexible and up‐to‐date as circumstances or required public health measures change over time, and might also aim to address misinformation or areas of uncertainty in order to further build public trust. Provision of tailored support, including practical and financial supports, for those at socioeconomic or other disadvantage may help people to adopt and adhere to measures.
Gilmore 2020#^ Citation type: SR (rapid) Public health measure: Contact tracing, and also maps onto isolation, quarantine, and general PD Mapping to: Uptake, acceptability Mapping to: Theme 2: recipients of public communication: audience, setting and equity Theme 4: community engagement to support communication Theme 5: public trust and perceptions	Overview and aim: To review evidence on community engagement for prevention and control of infectious diseases during epidemics Type of study and data: Rapid SR; 32 included empirical studies (any design) (describing 37 initiatives) plus 11 general guidance documents Inclusion and exclusion criteria: Included: community‐level engagement (range of collaborative processes with community actors). All languages Excluded: Interventions focused on community health workers without wider community engagement. Participant features and numbers, sampling details: Most activities were aimed at entire communities. Authors note a small number of studies targeted marginalised groups (e.g. non‐English‐speaking groups); including all 4 studies of H1N1 outbreaks in which equity was considered in relation to remote/aboriginal populations (but engagement was limited to design and planning activities only in these cases). Composition of community engagement groups often not reported, but some explicitly included marginalised groups (e.g. women representative, EVD survivors, youth). Included disease(s): Previous epidemics: EVD (28 studies), SARS (0), MERS (0), H1N1 (4), Zika (5) Timing: Searches May 2020; literature limited to those published from 2000 onwards Countries included: 28/37 for EVD (25 West African outbreak 2014‐15: Sierra Leone (11), Liberia (9) Guinea (2), Nigeria (1), Ghana (1), mixed country (1); 3 Democratic Republic of Congo 2018‐20 outbreak: Uganda (2)) 5/37 Zika (USA and Puerto Rico (3), Singapore (1), Uruguay (1)); 4/37 H1N1 (Australia (3), Canada (1)). Range of income brackets but most studies undertaken in low‐income countries Intervention or phenomenon of interest: Community engagement strategies Quality assessment: 5/11 AMSTAR [5. No excluded studies reported, unclear 7,8; Quality not assessed or used 9; Synthesis methods not clear and/or appropriate 10; Publication bias not formally assessed 11; COIs of included studies not reported] Funding source: Provenance: Not commissioned	Identified six broad community engagement approaches aiming to address infection prevention and control through six major channels Major actors or approaches included the following: community leaders (traditional, religious and/or governing); community and faith‐based organisations; community groups; health management committees; individuals; and key stakeholders (students, survivors, women, elderly, youth). Community engagement interventions operated via six main channels: designing and planning interventions (including messaging), community entry and trust building, social and behavioural change communication risk communication surveillance and contract tracing, and broader logistics and administration activities (e.g. constructing facility, record keeping). Community engagement was mostly used for social and behavioural change communication, and risk communication, followed by surveillance and contact tracing; many approaches were multi‐faceted & involved multiple actors. Key enablers and barriers for community engagement were identified from included research. Facilitators: Early engagement; Ensuring processes are ongoing and reassessing and modifying as needed; Ensuring multi‐sectoral engagement & decentralised governance; Ensuring there are clear roles and responsibilities for all stakeholders; Use of and engagement of pre‐existing actors (e.g. community groups; leaders) when appropriate; Having open communication, with clear two‐way dialogue. Barriers: Lack of contextual understanding (e.g. social norms, traditions, customs, and beliefs that are pervasive within that specific cultural context); Lack of engagement with appropriate actors; Inconsistent and confusing messaging; Lack of trust in government, media and organisations; Inadequate training, support structures, resources or incentivisation; Unclear responsibilities; Weak infrastructure or broader contextual conflict (e.g. poverty). Recommendations: Best‐practice recommendations were developed based on identified enablers and barriers: Community engagement should be context‐specific and consider the cultural/social norms, traditions, customs, and beliefs that are pervasive within that context; Discussions and negotiations (two‐way dialogue) with the community should begin early and be ongoing in order to build trust and should be established through multiple channels; Identification of issues, and design of prevention and control approaches and associated appropriate messaging (information, education and communication) should be undertaken collaboratively (co‐design). Community members who have legitimacy and are able to represent and influence the community should be involved; Messaging built on clear, accurate, consistent information can be used to help to build trust and address rumours and misinformation or misconceptions. Such information should be tailored to local context, respectful and not induce fear, and should include examples relevant to the community; Incorporating community members into planning, response and monitoring activities of pandemic management teams, with plans widely disseminated within communities to promote support. Topics might include population monitoring (e.g. surveillance and contact tracing systems), remote monitoring and alert systems, community response mechanisms for positive cases (e.g. social isolation and/or quarantine procedures, contact tracing), support for lockdown, isolation or quarantine especially for vulnerable populations (including providing essential supplies); Collaboratively working to identify and address health and safety issues in the early planning stages is key, including safe engagement activities, appropriate distancing measures for in‐person interactions, and community procedures for isolation and quarantine measures; For meaningful engagement, establishing mechanisms for regular feedback that monitor how knowledge, beliefs and practices/behaviours change over time, and to change or adapt course as required, is needed for inclusive and meaningful engagement.	Communication purpose: These findings can usefully inform development of community engagement strategies to support prevention and control measures during pandemic outbreaks. Community engagement can occur via different approaches and channels, and several features such as early and ongoing engagement are critical to success. Related to review questions: Community engagement approaches may involve a range of approaches, and channels, operating in various combinations to achieve different purposes, such as planning and design of interventions, trust‐building, and communication (including messaging) about risk and/or social and behavioural changes. To be most effective, community engagement incorporating two‐way dialogue should begin early and be ongoing in order to build trust within the community and to better understand the sociocultural context in which disease prevention and control efforts are needed. Community engagement can inform choice, development and/or appropriateness of measures required within specific groups; co‐design of messaging (information, education, communication) can help to ensure appropriateness and reach of messages to support public health measures. Messaging built on clear, accurate, consistent information, tailored to local context, can help to build trust, clarify misconceptions, and to directly address rumours and misinformation. Meaningful engagement should include mechanisms for regular feedback from the community in order to monitor knowledge, beliefs and practices/behaviours and their changes over time, and to adapt course as required.
Heuvelings 2018* Citation type: SR Maps to: Acceptability	Overview and aim: Evaluation of effectiveness (including cost‐effectiveness) of service models and organisational structures for TB identification and management Participant features and numbers, sampling details:Included: hard‐to‐reach populations (homeless people, drug users, migrants); countries with low‐to‐moderate TB incidence Intervention or phenomenon of interest: Included interventions: Effects of healthcare worker type or setting type on TB identification and/or management Type of study and data: SR; 11 included studies NICE and Cochrane methods followed; updates NICE review (previously included 6 studies) RCTs, non‐RCTs included Countries included:OECD, EU/EEA countries (UK, Portugal, Spain, Germany) Quality assessment: 7/10 AMSTAR rating% Funding source: Funders who supported this work: European Centre for Disease Prevention and Control; National Institute for Health Research (NIHR) (1): Grant ID: NF‐SI‐0616‐10016	Effectiveness of Community Health Worker (CHW), street teams, peers (screening uptake, treatment and contact tracing); mobile and specialised TB clinics (identifying cases and active treatment), directly observed therapy (treatment completion); Focus reported here is contact tracing activities only (2 studies); Involvement of CHWs from the same migrant community as the person with TB, in organising contact tracing improved tracing of contacts (1 study). Contact tracing was defined as tracing of at least one contact (rather than all contacts); Involving peers in contact tracing for drug users, compared with healthcare workers, also increased contact tracing (1 study). Recommendations: Improving TB control and care in hard‐to‐reach populations is critical. Involving CHWs from same migrant community or peers amongst drug using populations may improve contact tracing in these hard‐to reach groups. Both interventions were assessed as highly acceptable and likely feasible in recent guidelines including these studies$.	Communication purpose: This may inform decisions about who might most effectively conduct contact tracing in hard‐to‐reach populations such as the homeless and migrants. Related to review questions: Findings may provide insight into improving acceptability of contact tracing.
Khorram‐Manesh 2021# Citation type: SR Public health measure: Contact tracing, and also maps onto General PD Mapping to: Uptake, acceptability, adherence Mapping to: Theme 2: recipients of public communication: audience, setting and equity Theme 5: public trust and perceptions	Overview and aim: To systematically review the literature to identify educational strategies to promote public health measure implementation, particularly contact tracing, prior to public health emergencies Type of study and data: SR; quantitative and qualitative, N = 52 studies Inclusion and exclusion criteria: Included: research, English language Excluded: conference papers, abstracts, reports, and non‐scientific publications Participant features and numbers, sampling details: General public/communities No particular demographic features reported Included disease(s): COVID‐19, H1N1 Timing: Search dates unclear; the majority of papers from 2020, 2021 Countries included: US and Canada (16 studies), Asia‐Pacific (13). European Union (9), UK (7), Middle East (3), Africa (3). Range of income levels, 38/52 high income; remainder of countries middle income (lower‐to‐upper middle) Intervention or phenomenon of interest: Educational strategies to support public health measure implementation Quality assessment: AMSTAR 5/11: [1. No protocol/plan 5. No list of excluded studies 6. Included study characteristics inadequate 8. Quality not integrated explicitly into findings 10. No publication bias assessment 11. No COIs for included studies] Funding source: This research received no external funding.	Four main themes were identified. Practical aspects Contact tracing apps must fulfil technical requirements, identifying not only close contacts within an individual’s social networks but casual contacts e.g. as a fellow bus passenger. The process must provide valid and accurate data, and many such systems now exist, e.g. GPS information, QR codes, cellular location tracking. Simple, safe technology may increase people’s willingness and ability to participate in contact tracing and so improve the reliability and impact of the system on disease transmission. Ethical aspects Many contact tracing apps not able to be used on certain older device types, meaning that vulnerable people in the population (e.g. the elderly and the poor) are unable to participate and/or cannot access the technology to participate. There are also concerns related to an individual’s rights to opt out of contact tracing; privacy and data collection issues; and recognised need for new legislation to safeguard a return to normal life once the crisis is over in order to promote public trust for people to consider participating in mass surveillance strategies. Psychological aspects People’s beliefs and reasoning influence their use (or non‐use) of contact tracing apps. Themes in participants’ responses include lack of information and misconceptions associated with the COVID‐19 tracing app; privacy, stigma and uptake concerns; and contact tracing as a benefit for the population. Concerns about privacy, stigma and uptake may particularly negatively influence willingness to use an app. The use and impact of technologies may vary by age or underlying conditions (medical or psychological). Challenges such as difficulties in adopting changes to daily routines or precautionary (preventive) measures may lead to anxiety, stress, worry, despite being well‐informed and well‐connected via an app. Circulating rumours may also influence people’s emotions, increasing anxiety and anger. Quarantine and isolation measures may be associated with increases in distress, suspiciousness and other negative outcomes. Such factors may negatively influence adherence to isolation, contact tracing, and following recommended protective measures. Community‐level education Although the majority of populations (> 75%) across EU countries have downloaded contact tracing apps, it is unclear how well this corresponds with actual use. As information is critical to implementing new ideas and technology, public education is needed to support use. Previous studies during the H1N1 pandemic indicated that inadequate community awareness of the disease and its prevention was a major barrier to successful management of the disease. Other prior studies have also indicated that adding details specific to communities, such as information about resources and supplies, and information about whom, when, where and how recommendations are to be implemented, are critical elements. Examples exist from low and middle‐income countries of efforts to engage and mobilise communities in detection of cases through community‐based workshops and via social media. New technologies may be a facilitator of community engagement, for example, digital technologies might be used as a basis for informing community members about the size and progress of the pandemic, and they may also be enlisted to support public health measures such as surveillance activities. While apps must fulfil certain technical requirements, they must also be tailored to people’s general and health literacy levels. The health information acceptance model suggests some key factors influencing uptake and use of new technologies, including health factors (perceived usefulness, perceived threat), information‐related factors (subjective social norms, credibility of the technology) and technical factors (such as perceived output quality, usability). Recommendations: Contact tracing efficiency depends inherently on the public’s willingness to engage with authorities and the process. In turn, this depends on the public’s trust of the government in terms of measures imposed to protect health and to protect privacy. Increased availability of technology presents the option of using these as a basis for protection of public health (digital health protection measures) and enable social networking but also have ethical and psychological impacts that need to be factored into decision‐making. In the current pandemic, where treatments and vaccines were lacking, physical distancing measures were the key available public health strategies. These also carry societal and ethical impacts that may influence levels of adherence, and this may vary across countries and populations. Lack of adherence to physical distancing measures may be due to disagreement with the social restrictions, but in other cases the cause is more fundamental and reflect the needs of people under public health surveillance e.g. reflecting issues associated with housing and living arrangements, transport, education, food and essential household supplies. Addressing these needs may help to increase people’s willingness to adhere to physical distancing measures such as quarantine. The current COVID‐19 pandemic and deployment of digital public health technologies have led to efforts to produce guidelines and policies with an emphasis on personal data safety and privacy, and so ensure widespread public trust and uptake. As well as providing information and ensuring quality, to minimise misconceptions, efforts to better understand factors affecting app usability are key, including in relation to contact tracing apps. Public education at all levels but particularly community level, is also needed to support these apps, by increasing perceived usefulness and ease of use. Education needs to be tailored and targeted within the population, including towards people with lower health literacy, who may otherwise be unable to effectively engage with apps and associated public health measures.	Communication purpose: Findings may inform strategies to support implementation of public health measures such as contact tracing, including public education and various forms of support for physical distancing measures. Related to review questions: Simple, safe technology may increase people’s willingness and ability to participate in contact tracing, but adequate information must be provided about apps used for public health protection, and specific concerns such as those about data protection and privacy, and stigma must be addressed to promote uptake and adherence. Education to increase community knowledge and awareness of the disease and preventive measures is also needed. Tailored information specific to communities may assist with uptake and adherence, and such information needs to include targeting to those in the community of lower general or health‐specific literacy levels. Use of digital technologies for public health measures must consider that people may have differential access to devices that can support apps (e.g. older devices may not run, older people may not have access to technology), and that this may further marginalise vulnerable groups within the community, such as those who are older or poorer. Information and education for the public needs to consider not only information provision related to public health measures but the emotional, psychological and practical impacts of the measures.
Megnin‐Viggars 2020# Citation type: SR, rapid Public health measure: Contact tracing Mapping to: Uptake, acceptability Mapping to: Theme 1: features of public communication: content, timing and duration, and delivery Theme 4: community engagement to support communication Theme 5: public trust and perceptions	Overview and aim: To identify barriers and facilitators to community uptake of, and engagement with, contact tracing during an infectious disease outbreak Type of study and data: Rapid SR; qualitative and quantitative research; 12 included studies (6 qualitative interview and focus group studies, 5 quantitative surveys, 1 mixed methods (qualitative interview plus quantitative survey)) Inclusion and exclusion criteria: Included: Primary qualitative or quantitative research; English language; assessed factors related to contact tracing Excluded: experience of non‐viral and contagious major health incident, sexually transmitted diseases Participant features and numbers, sampling details: People with experience of a major viral and contagious health incident; included general population, contact tracers and their supervisors, public health professionals, CDC staff Included disease(s): COVID‐19 (6 studies), EBV (5), hypothetical (1) Timing: Searches from inception to July 2020 inclusive Timing of population and communication not otherwise considered explicitly Countries included: Single country studies: UK (3), Sierra Leone (3), Netherlands (2), Australia (1), & Liberia (1) Multiple country studies: Sierra Leone, Guinea, Liberia, Mali, Senegal, Nigeria; France, Germany, Italy, UK, US West African countries low income except Senegal (lower middle income); others all high income Intervention or phenomenon of interest: Community engagement with contact tracing, and factors affecting (positive and negative) Quality assessment: 8/11 AMSTAR [8. Quality assessed but not linked to findings explicitly; 10. Publication bias not assessed; 11. COI included studies not reported]. Funding source: PC and OMV were funded by Go‐Science; the review was conducted at the request of the Scientific Pandemic Influenza Group on Behaviours (SPI‐B), a behavioural science advisory group for the Scientific Advisory Group for Emergencies (SAGE): Coronavirus (COVID‐19) response team, who provide scientific and technical advice to support UK government decision‐makers. GJR and DW were funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response, a partnership between Public Health England, King’s College London and the University of East Anglia. DW is also supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Behaviour Change and Evaluation, a partnership between Public Health England and the University of Bristol.	Reported on: Barriers and enablers of uptake of and engagement with contact tracing (CT) were identified. Enablers: Four themes were identified. Collective responsibility Participants’ sense of collective responsibility and desire to protect others’ health, especially the vulnerable in the community, strongly influenced intention to use a contact tracing app. One study found creating a positive image of contact tracers helped emphasise collective responsibility. Personal benefit Participants positively viewed the capability of a contact tracing app to provide information about infection risks, symptoms and disease spread, so providing peace of mind. In contrast, where people did not intend to use an app, this was typically because they did not see a personal benefit of doing so (and doubted their usefulness). Various reasons were given, including: people believing existing measures (e.g. physical distancing) were adequate, not believing they would be infected, believing such apps lead to hyper‐awareness of risks and increased stress, or believing that contact tracing apps were less acceptable in countries like the UK than in others where apps have been widely implemented. Where personal benefit was initially lacking, this could be improved in specific ways e.g. providing financial support/incentives to those contacted. Co‐production of CT systems Working with the community is critical to understanding local needs and implementing contact tracing, and to building engagement and trust. Co‐production may also improve app usage as intention to use an app is related to people’s understanding of government advice. Community engagement may help to identify contacts and overcome stigma related to contact tracing. Perception of system (as efficient, rigorous, reliable) People viewed digital CT systems as able to efficiently and effectively contact people, and that such systems might empower the individual as the holder of their own data and enable information sharing. Barriers: 5 themes identified. Privacy People’s concerns about government surveillance, privacy and data protection was a major barrier to CT engagement. Mistrust and/or apprehension Mistrust (of government, CT personnel and technology) was a key barrier to CT engagement, a technology barrier for older people. Prior experience of CT and concerns over what may be required (and associated financial and social pressures) was associated with apprehension. Some mistrust/apprehension of digital CT systems related to uncertainty about system effectiveness, concerns about whether people would engage with systems lacking human interface, and that poor uptake would limit usefulness. Unmet information and support needs Gaps in knowledge (information) were associated with mistrust and apprehension. People lacked information about why CT is needed, whether a digital system was capable of conveying the right information, and that information might be conflicting (e.g. with websites) or be unclear about actions to take. Digital CT systems might be limited as digital information may be perceived as more severe than that coming from another person, and there was limited opportunity to provide reassurance or support. Fear of stigmatisation Fear of being ‘branded’ as COVID‐19 positive was related to privacy concerns. Mode‐specific challenges Practical barriers to using a contact tracing app may exist (e.g. people not owning appropriate devices, difficulty installing, downloading or running the app, requiring more interactivity to allow test or symptom reporting), as well as psychological barriers to engaging with technology (e.g. perceived difficulty of installation or use). Manual systems also encounter practical difficulties e.g. challenges identifying contacts, and in recruiting and retaining contact tracers. Recommendations: Engagement with CT systems might be enhanced through: Clear, consistent information and communication about contact tracing, including why it is needed and how it will work (specific, actionable behaviours required to engage with the system), and conveying both personal and collective benefits as well as providing support (including financial support). Promoting feelings of collective responsibility in countering disease outbreaks, as well as perceived personal benefit. This has to outweigh barriers such as privacy concerns and mistrust. Partner with communities to ensure local needs are met and promote trust and engagement. Co‐producing CT systems with stakeholders may help address privacy and stigma concerns, and improve mistrust and apprehension about use. Quality assurance of CT systems to ensure they are efficient, rigorous and reliable, and to reinforce these perceptions within the community.	Communication purpose: May inform development and implementation of contact tracing systems, as well as development of messages for communicating with the community to promote engagement with contact tracing systems. Factors may inform messaging and activities used to develop and support CT systems, as well as practical measures to overcome barriers to engagement. Related to review questions: Several factors, both enablers and barriers, influence individual and community engagement with contact tracing systems. This in turn, affects acceptance and uptake of systems. Communication intended to inform people about contact tracing measures need to take account of these factors and ensure that clear, consistent and actionable information is available. Both information and CT systems should be tailored appropriately to the local context. Messages might usefully promote both individual and collective benefits of contact tracing systems, while partnerships with communities may help to counter mistrust and concerns over privacy and stigma.
Saurabh 2017* (SR) Mapping to: Acceptability	Overview and aim: Assessment of the role of contact tracing in the 2014 Ebola epidemic and to identify factors influencing health workers’ ability to perform contact tracing Inclusion and exclusion criteria: Included: populations or communities exposed to EVD outbreak Type of study and data: SR; 60 included studies/reports. Primary studies (no details), technical reports, reviews, editorial documents Countries included: West Africa (Guinea, Sierra Leone, Liberia, Congo), also USA, Spain Quality assessment: 1/11 AMSTAR rating (critically low quality according to AMSTAR 2) Funding source: Not reported	Reported on: Utility of contact tracing for controlling EVD outbreaks. Exposed person followed for 21 days (maximum EVD incubation period); Challenges in implementing contact tracing, and at different stages of an EMV outbreak (early or later); Tracing all contacts is logistically challenging (e.g. due to absence of specific address, full name), and only effective if performed soon after case identification; Effective contact tracing relies on active community involvement, which is affected by understanding of the disease, trust, fear and stigma; Successful contact tracing depends on accurate, culturally sensitive communication to ensure the appropriate message is communicated, as well as psychosocial support provided for community members; Engaging and educating community leaders, religious groups and mass media communication to promote awareness of accurate information in affected communities is key; Contact tracing has huge potential to control disease outbreaks but for EVD could not be put in place in most affected settings due to huge caseload and limited healthcare staff; Although not implemented early in the outbreak, later control efforts relied heavily on contact tracing, and success was attributed largely to community involvement, promoted through international efforts. Recommendations: Contact tracing has enormous potential to reduce cases of EVD but relies on trust and accurate and appropriate communication with communities, including community leaders, to be successfully implemented. Engaging and educating communities by communicating accurate information in different ways is critical for ensuring that contact tracing can be performed.	Communication purpose: Findings may inform decisions about how and who to provide information to about disease outbreaks and subsequent contact tracing efforts. Related to review questions: Findings may provide insight into improving acceptability of contact tracing and factors influencing uptake (ability to perform) contact tracing in communities.
Szkwarko 2017* (SR) Mapping to: Adherence	Overview and aim: Tuberculosis Child Contact Management (CCM) implementation, challenges, predictors, and recommendations Inclusion and exclusion criteria: Included: Child population (< 15 years) exposed to TB in household in high‐burden countries. All quantitative, qualitative and mixed‐methods studies Excluded: randomised controlled trials, editorials, or commentaries Type of study and data: 37 studies included (25 quantitative, 3 qualitative, 9 mixed methods) Countries included: 22 studies in African region (most in South Africa (10), Ethiopia (4) and Malawi (3)), 14 in Southeast Asia (most in India (5), Indonesia (4)), and one in the Americas (Peru) Quality assessment: 6/11 AMSTAR rating Funding source: K01 AI104351/AI/NIAID NIH HHS/United States	Reported on: Focus reported here is on contact identification and tracing (not screening, treatment). Child contact (< 5 years) identification varied widely (24 to 1227 child contacts). Challenges for contact management/tracing included the following: Health system infrastructure challenges (lack of prioritisation, limited resources, lack of tools to support contact tracing and documentation). Knowledge gaps amongst index cases, caregivers and healthcare workers were apparent, with inadequate health education or lack of understanding of information on CCM, particularly caregivers were not informed about the need for child contact screening and the importance of preventive therapy. Healthcare workers also showed knowledge gaps. Lack of guidelines, and non‐adherence to guidelines were also found in many studies (n = 21). Another concern was stigma, with caregivers expressing child contact screening could lead to unwanted disclosure of TB and/or HIV to others (n = 5). Other major barriers or challenges to child contact screening included difficulties accessing care (e.g. due to cost, transportation difficulties) and family prioritisation of other competing priorities (i.e. parents' work schedules, child contacts need to go to school). Recommendations: A focus should be on a CCM‐friendly healthcare environment with improved CCM processes and tools; extensive health education for healthcare workers, index cases, caregivers and the community; and active, evidence‐based strategies to decrease barriers such as those in accessing care and competing priorities.	Communication purpose: This may be used for communication with parents to enhance compliance with contact tracing measures, by filling knowledge gaps, decreasing stigma, and increasing perceived importance of contact tracing. Findings may also help to inform decisions about how to decrease barriers to contact tracing measures, such as difficulties with access, or on stigma associated with TB. Related to review questions: Findings identify factors that may impact on non‐adherence to child contact tracing measures, such as knowledge gaps and competing demands.
Primary studies
Bodas 2020# (primary) Mapping to: Adherence Also mapping to: Public health measures 3 (quarantine) and 2 (isolation) rather than contact tracing	Overview and aim: Assessment of public attitudes to self‐quarantine for COVID‐19, including economic factors (compensation for lost wages) as a factor influencing compliance Inclusion and exclusion criteria: Included: adults (18 years and older) Type of study and data: Cross‐sectional survey; 563 participants (representative randomised sample of population of State of Israel) Countries included: Israel Quality assessment: Response rate: + representativeness: ++ COI not declared; results rely on self‐reported intentions (not behaviours), at a single time point; sample may under‐represent those without computer skills/Internet; paper peer reviewed and published	Reported on: Public attitudes to COVID‐19 outbreak, including personal concern, attitudes towards public health regulations and compliance with public health regulations, including when compensation was provided or not. Most (60%) respondents reported monitoring the situation via news reports; over 80% report moderate or higher levels of concern about the outbreak; and over 80% a moderate or higher rating of trust of the Ministry of Health in current outbreak. 94% of respondents indicated intention to comply with two‐week self‐quarantine period when compensated for lost wages; when compensation was removed intended compliance decreased to 57% (11% indicated they would no longer comply). Recommendations: Decision‐makers must take into account the effects of monetary compensation on compliance with self‐quarantine measures. Risk communication may be targeted towards those who are undecided about self‐quarantine compliance in the absence of compensation (approximately 30% of respondents).	Communication purpose: This may inform communication with communities to prevent transmission through adherence to public health measures (short‐term (2 weeks) self‐quarantine), and for communicating with and supporting people undecided about behavioural compliance in the absence of financial compensation. Related to review questions: Findings identify factors influencing behavioural adherence to public health measures, particularly those related to monetary compensation and effects (that financial security is important for guaranteeing adherence to proposed measures).