Keywords
smart phone - Electronic health records and systems - information assurance - public
health - statistical methods - General information systems and technologies in clinical
settings
Background and Significance
Background and Significance
During the height of the coronavirus disease 2019 (COVID-19) pandemic, public health
mandates limited social contact and travel, compelling the implementation of measures
to monitor and manage behavior that could impact public health.[1]
[2] As vaccines and boosters became available, restrictions were gradually relaxed;
in some cases, proof of vaccination or a negative COVID-19 test result was required
to participate in activities or enter venues or businesses.
Providing proof of vaccination status took many forms. Initially, most individuals
provided the paper CDC vaccine card as proof of vaccination.[3] Subsequently, after a rapid development process, Washington (WA) state along with
other U.S. states and several countries provided access to mobile tools developed
to facilitate sharing of COVID-19 vaccine status. Washington's Verifiable Clinical
Information (VCI) tool is called WA Verify and was built on the SMART Health Card
framework,[4]
[5]
[6] providing a convenient means for individuals to obtain and show proof of their COVID-19
vaccine status. To use WA Verify residents may visit the tool's Web site and enter
their name, date of birth, and either an email or phone number. Users then receive
a QR code via the entered contact information. This code can be stored on a smartphone
or printed on a piece of paper.
Prior to roll-out, little empirical evidence had been collected on expected acceptance
and uptake of a tool like WA Verify. Although there are several examples of vaccine
verification tools implemented across the country,[7]
[8]
[9] reports on uptake, acceptance and usage practices are scant. The acceptability of
a hypothetical tool to show vaccination status was considered in multiple studies
and these studies found that interest in the tool ranged from 60–80%, though acceptability
of requirements for sharing vaccination status imposed by various entities was far
lower.[10]
[11]
[12]
[13]
[14] Some have also considered ethical and economic concerns related to policies requiring
proof of vaccination for entrance to dining or entertainment venues.[15]
[16]
[17] However, WA Verify was designed as an alternative method of providing vaccination
information rather than a policy or stance regarding whether or not proof of vaccination
should be required.
Soon after the November 2021 system launch, WA Verify saw large numbers of requests
from WA residents seeking access to their vaccine records through the tool. Although
millions of records requests have now been made, due to its rapid implementation,
little was known about how the public received the tool, barriers to acceptance and
utilization, or the factors that influenced adoption. More broadly, little was known
about how WA state residents interact with and feel about technology related to public
health in general. To address this knowledge gap and to evaluate acceptance of WA
Verify, a survey targeting WA residents was developed and administered.
This survey and its results represent one of the first comprehensive reports on the
knowledge, attitudes, and practices surrounding a digital vaccine verification technology
that has been widely implemented at the state level. This large, methodologically
robust survey provides a detailed description of WA state and can inform implementation
of useful tools that are accepted by the community, promote health equity and improve
health outcomes. While many high-level results are presented here, further analyses
have been conducted and can be found both in the appendix and in other published work.[18]
Objectives
This study sought to inform the development of WA Verify through the implementation
and analysis of a representative, address-based survey of Washington residents. Specifically,
the survey and corresponding analysis focused on tech literacy, experiences with vaccine
verification and knowledge and opinions regarding WA Verify and public health policies
meant to limit the spread of COVID-19.
Materials and Methods
The survey was designed and analyzed by the University of Washington's WA Verify evaluation
team in the School of Public Health in partnership with the WA State Department of
Health (WA DOH). The Social and Economic Sciences Research Center (SESRC)[a] at Washington State University implemented the survey, carrying out sampling as
well as printing, translation, web hosting, mail distribution, and data entry.
Survey Design
A brief survey was designed for both paper/mail and electronic completion. Survey
questions were developed iteratively and focused on the following areas: experiences
with COVID-19, situations requiring proof of vaccination or testing, barriers and
facilitators to use of public health digital tools, and basic demographic information.
After an iterative design and review process, the survey included 32 questions and
took approximately 10 minutes to complete. The complete survey instrument can be found
in the [Supplemental Files].
Data Collection
The target population was adult residents of WA state. A simple random sample of 5,000
addresses was obtained from a database based on the United States Postal Services
Delivery Sequence File[19] with a 97% coverage rate. On September 15, 2022, letters were mailed to all 5,000
addresses in the study sample. The initial invitation letter informed recipients about
the survey and included instructions for completing the survey online. The initial
mailing ([Supplementary Material]) included links to the online instrument and a $5 bill as an incentive. One week
after the initial mailing, a reminder postcard was sent to those who had not yet completed
the survey). On October 12 and November 14, a paper questionnaire, cover letter, and
postage-paid return envelope were mailed to all addresses for which the survey had
not yet been completed online. A Spanish language translation of the letter was also
included in the November 14 mailing. A final reminder was sent to nonrespondents on
December 1, 2022, with a random subset receiving $1 bills with the mailing. The survey
closed on January 9, 2023. More details about the distribution timeline are described
in the Appendix and shown in [Fig. 1].
Fig. 1 Distribution of Web and mail survey responses over time. On September 15, 2022, postal
invitation letters were mailed to all 5,000 addresses in the study sample. Each bar
represents 5 days. The first survey was received on September 16, 2022 and the last
included survey was received on January 9, 2023.
Statistical Analysis
The demographic characteristics of the survey sample were summarized using sample
proportions. Additionally, these sample proportions were compared with those of WA
state as described by the United States Census Bureau, American Community Survey 2021
5-year estimates.[20]
[21]
[22]
[23]
[24]
[25]
[26]
[27] In an effort to improve further analyses, calibration weights were also created
for the dataset based on race, ethnicity, age, and sex. Based on these weights, we
estimated the number of WA Verify users in Washington and compared this estimate to
the number of QR code download requests, which is known exactly. For more details
on our weighting method ([Supplementary material]).
To better understand the barriers and facilitators to use of digital verification
in the state, comparisons of four outcomes were considered across multiple demographic
factors. The outcomes included: experience being asked for proof of vaccination or
a negative test, hearing about WA Verify, using WA Verify, and support of vaccination
or testing requirements. The demographic characteristics considered were age, gender,
region of Washington (East vs. West), race and ethnicity, and education level. The
two regions of Washington considered here are based on county lines with the division
largely dictated by the Cascade Mountain range passing through the state ([Supplementary Fig. S7]). The eastern portion of the state is less metropolitan[28] with a different economic makeup. As a result of this and other factors, the eastern
region of Washington is generally more conservative, less well educated, has higher
rates of poverty, and lower rates of employment than the western region ([Table 1]). Eastern versus Western Washington regional comparisons are often informative for
local public health practice to better tailor interventions to the population served.
Table 1
Demographic differences between Western and Eastern Washington
|
Covariate, ACS table code[a]
|
Region
|
|
West
|
East
|
|
Percentage of Individuals over 25 with a bachelor's degree or more, B15003
|
40
|
27
|
|
Percentage of families with an income below the poverty line in the past year in Washington,
B17010
|
6
|
9
|
|
Percent of individuals over 25 who are in the labor force, B16010
|
66
|
61
|
|
Percent of all individuals living in a rural environment[b]
|
87
|
72
|
a All statewide measures are taken from the American Community Survey Data. Data from
the 5-year estimates for 2021 are used throughout with the code for the specific table
used given in the first column.
b Based on the U.S. Census Bureau's urban–rural classification
R version 4.3.2 (2023-10-31) and the R package Dplyr 1.1.4 was used. Descriptive data
were presented as counts and percentages.
Results
Of the 5,000 invitations mailed, 1,491 households responded to the survey, and 302
invitations were returned as undeliverable. The response rate for the survey (defined
as the number of fully and partially completed surveys divided by the number surveys
not returned)[29] was 32%. Three-quarters of the respondents (1,133, 76%) completed the survey online;
358 (24%) completed and returned the paper survey. All respondents completed the English
language version of the survey; none of the Spanish translated questionnaires were
returned.
Demographics
For many of the demographic characteristics, including race/ethnicity, disability
status, household size, and WA region (East vs. West), the survey sample proportions
were comparable to WA state as a whole. There were, however, some exceptions. The
sample had a lower proportion of male respondents (37.8%) than WA state (50.3%). Relative
to WA state, the sample included fewer young individuals 18 to 29 years (sample: 9.0%
vs. WA: 20.7%) and had a higher proportion of older individuals 70 to 79 years (sample:15.7%
vs. WA: 8.7%). In the case of educational attainment, the sample had a higher proportion
(56.2%) of “4-year degree or more” graduates compared with the state overall (37.3%).
A smaller proportion of our survey respondents spoke a language other than English
at home (11.3%) compared with WA state as a whole (20.3%).
[Table 2] presents the weighted and unweighted sample proportions as well as the reference
proportion for the state average for each of the considered variables. The last column
of the table lists the ratio of the sample proportion (both weighted and unweighted)
to the reference; values closer to 1 indicate a more representative sample. It is
noteworthy that while some variables (such as language spoken at home) better match
the reference when weighted, others see little improvement from weighting (e.g., education).
Table 2
Demographics of the unweighted and weighted samples compared with WA state demographics
|
Attribute, ACS table code
|
Values/range
|
Count
|
Percent[a]
|
Weighted percentage
|
Washington statewide percentages[b]
|
Survey percent over state percent: unweighted (weighted)
|
|
Gender, B01001
|
Female
|
813
|
58.7
|
50.0
|
50.0[c]
|
1.19 (1.00)
|
|
Male
|
563
|
40.7
|
50.0
|
50.0[c]
|
0.81 (1.00)
|
|
Transgender
|
3
|
0.2
|
|
|
|
|
Nonbinary/nonconforming
|
5
|
0.4
|
|
|
|
|
Prefer not to respond
|
44
|
|
|
|
|
|
Missing
|
63
|
|
|
|
|
|
Age, B01001
|
18–29
|
134
|
9.4
|
20.7
|
20.7
|
0.44 (1.00)
|
|
30–39
|
221
|
15.5
|
19.0
|
19.0
|
0.83 (1.00)
|
|
40–49
|
205
|
14.4
|
16.3
|
16.3
|
0.89 (1.00)
|
|
50–59
|
234
|
16.4
|
16.0
|
16.0
|
1.02 (1.00)
|
|
60–69
|
315
|
22.1
|
15.0
|
15.0
|
1.48 (1.00)
|
|
70–79
|
234
|
16.4
|
8.7
|
8.7
|
1.93 (1.00)
|
|
80+
|
84
|
5.9
|
4.3
|
4.3
|
1.32 (1.00)
|
|
Missing
|
64
|
|
|
|
|
|
Race and ethnicity, B03002
|
American Indian or Alaska Native (AIAN) alone
|
4
|
0.3
|
0.4
|
0.9
|
0.32 (0.43)
|
|
Asian alone
|
112
|
8.2
|
10.2
|
8.9
|
0.92 (1.15)
|
|
Black alone
|
36
|
2.6
|
3.4
|
3.7
|
0.71 (0.92)
|
|
Hispanic/Latinx any race
|
75
|
5.5
|
13.2
|
13.2
|
0.41 (1.00)
|
|
Native Hawaiian and Other Pacific Islander (NHOPI) alone
|
6
|
0.4
|
0.5
|
0.6
|
0.68 (0.74)
|
|
Two or more races specified
|
60
|
4.4
|
5.0
|
5.8
|
0.76 (0.86)
|
|
Some other race alone
|
17
|
1.2
|
0.8
|
0.4
|
3.23 (2.21)
|
|
White alone
|
1,060
|
77.4
|
66.5
|
66.5
|
1.16 (1.00)
|
|
Missing
|
121
|
|
|
|
|
|
Highest level of education,
B15003
|
Less than high school
|
13
|
0.9
|
1.4
|
8.1
|
0.11 (0.17)
|
|
High school graduate
|
187
|
13.2
|
13.2
|
21.8
|
0.52 (0.55)
|
|
2-y degree or some college
|
384
|
27.0
|
26.7
|
32.8
|
0.82 (0.81)
|
|
4-y degree or more
|
838
|
58.9
|
58.7
|
37.3
|
1.58 (1.57)
|
|
Missing
|
69
|
|
|
|
|
|
Disability,
B18101
|
Yes
|
197
|
14.7
|
12.6
|
13.7
|
1.08 (0.92)
|
|
No
|
1140
|
85.3
|
87.4
|
86.3
|
0.99 (1.01)
|
|
Prefer not to respond
|
89
|
|
|
|
|
|
Missing
|
65
|
|
|
|
|
|
Speak language other than English at home, B16001[21]
|
Yes
|
168
|
11.9
|
19.7
|
20.3
|
0.59 (0.97)
|
|
No
|
1240
|
88.1
|
80.3
|
79.7
|
1.10 (1.01)
|
|
Missing
|
83
|
|
|
|
|
|
Household size,
B08201
|
One (live alone)
|
324
|
22.8
|
10.1
|
10.5[d]
|
2.18 (0.97)
|
|
Two
|
608
|
42.8
|
33.0
|
27.8[d]
|
1.54 (1.19)
|
|
Three
|
213
|
15.0
|
18.3
|
18.2[d]
|
0.82 (1.00)
|
|
Four or more
|
275
|
19.4
|
38.6
|
43.5[d]
|
0.44 (0.89)
|
|
Missing
|
71
|
|
|
|
|
|
Parent or guardian to child under 18,
B11003
|
Yes
|
336
|
23.6
|
34.0
|
42.7
|
0.55 (0.80)
|
|
No
|
1086
|
76.3
|
66.0
|
57.3
|
1.33 (1.15)
|
|
Missing
|
69
|
|
|
|
|
|
Region of Washington,
B01001
|
Eastern
|
283
|
19.0
|
18.3
|
21.7
|
0.88 (0.84)
|
|
Western
|
1208
|
81.0
|
81.7
|
78.3
|
1.03 (1.04)
|
a Calculated percentages do not include missing values.
b All statewide measures are taken from the American Community Survey Data. Data from
the 5-year estimates for 2021 are used throughout, with the code for the specific
table used given in the first column.
c Note that census percentages are based on only those 18 and older to match the joint
age–sex distribution used when creating weights.
d Household size is reported by the census as a per-household average. This average
is adjusted to be a per-person average with 4 or more individual households being
assumed to have an average of 4.9 individuals (selected to align with the population
count).
While the exact number of individuals using WA Verify is not known, the WA DOH reported
that QR codes had been downloaded 1.7 million times between October 25, 2021, and
January 9, 2022. Although the number of downloads is expected to be larger than the
number of WA Verify users because individuals can request QR codes multiple times,
it is roughly in line with the estimated 26.4% of WA state residents (18 or older)
using WA Verify from the weighted survey, which would correspond to roughly 1.5 million
users in the state.
Experiences with Coronavirus Disease 2019 Vaccine Verification
Roughly two-thirds of respondents (66.5%) reported being asked for proof of COVID-19
vaccination or a negative COVID-19 test during the 12 months prior to receiving the
survey. A little over half of respondents (54.0%) had not heard of WA Verify before
receiving the survey, and a majority (72.8%) reported they did not use WA Verify or
a similar tool ([Table 3]).
Table 3
Experience with vaccine verification, familiarity with, and use of WA Verify
|
Question
|
Yes (%)
|
No (%)
|
No, but use similar tool
|
Missing (%)
|
|
In the last 12 mo, have you been asked to show proof of COVID-19 vaccination, or a
negative COVID-19 test result before participating in an activity or entering a business?
(Q06)
|
991 (66.5%)
|
481 (32.3%)
|
–
|
19 (1.3%)
|
|
Before receiving this survey, had you heard about WA Verify? (Q08)
|
665 (44.6%)
|
805 (54.0%)
|
–
|
21 (1.4%)
|
|
Do you use WA Verify? (Q12)
|
309 (20.7%)
|
1085 (72.8%)
|
50 (3.4%)
|
47 (3.2%)
|
Situations Requiring Proof of Vaccination and/or Negative Test Results
Requests for proof of vaccination were primarily reported before entering establishments,
attending events, entering the workplace, and when booking travel or prior to boarding.
Far fewer respondents reported requests for negative COVID-19 tests, and such requests
were most often made when booking travel, entering the workplace or visiting a health
care facility. [Fig. 2] shows more details on reported requests for proof of vaccination and negative test
results.
Fig. 2 Situations where respondents were asked for proof of vaccination or negative test
results.
Barriers and Facilitators to Using Public Health Digital Tools
When asked about reasons to use a tool like WA Verify, the most common responses included
the tool's convenience (73.9%) ease of access to events and venues (56.4%), making
health care check-ins and access easier (55.1%) and as a good way to protect one's
community (49.0%). Primary reasons for not using a tool like WA Verify included not
needing to show vaccine status for school or work (44.1%) or other activities (28.9%),
concerns about data security (38%) and not wanting public health authorities accessing
personal data (28.7%). [Figs. 3] and [4] summarize reasons for using and not using a tool like WA Verify, respectively.
Fig. 3 Reasons to use a tool like WA Verify. Reported percentages are for responses to “Reasons
why someone might choose to use a portable electronic COVID-19 vaccine record like
WA Verify.” While 3.6% of participants wrote in a response, they are not listed here.
Fig. 4 Reasons to not use a tool like WA Verify. Reported percentages are for responses
to “Reasons why someone might NOT want to use a portable electronic COVID-19 vaccine
record like WA Verify.” Options in gray were created based on participant write-in
responses and 1.9% of participants wrote in a reason not listed above.
Many respondents (74.6%) supported public health policies requiring proof of vaccination
or negative COVID-19 test results. Although there was agreement that a technology
like WA Verify would help limit the spread of COVID-19 (63%), there was also concern
that only smartphone owners would benefit from such a tool (61%) and those with lower
digital skills would be left out (62%). Opinions on other possible positives and negatives
of digital health technology are summarized in [Fig. 5].
Fig. 5 Opinions about public health technology like WA Verify. Reported percentages are
for responses to “Using new technologies like WA Verify….”
Survey respondents were also asked how they would prefer to have information shared
with them. Health care-related sources—either from health care providers (76.1%) or
during COVID-19 vaccine appointments (68.7%)—were the most popular. More than half
of respondents indicated they would like to receive public health-related information
through the news (64.7%). The popularity of other communication sources is summarized
in [Fig. 6].
Fig. 6 Communication preferences for receiving information about WA Verify or similar tools.
Reported percentages are for responses to “How would you like to receive information
about WA Verify or similar tools that aim to support public health efforts to improve
the health of all communities in our state?” Options in gray were created based on
participant write-in responses and 2% of participants wrote in a source to receive
information not listed above.
Among the notable trends in awareness of, use of and interest in WA Verify, younger
individuals and more highly educated individuals were more likely to have been asked
for proof of vaccination, have heard of WA Verify, and to be using WA Verify than
their older and less educated counterparts. Additionally, support for requiring proof
of vaccination was higher among Asian individuals (94%) compared with other races.
While differences across all groups were observed, substantive differences were seen
between the two regions of Washington for each of the considered questions ([Table 4]).
Table 4
Frequency of demographic characteristics and within-group experiences regarding vaccine
and test verification, awareness, use, and support of WA Verify
|
Group size
|
Percent asked for proof[a]
|
Percent heard WA Verify[b]
|
Percent use WA Verify[c]
|
Percent supporting WA Verify[d]
|
|
Age
|
|
18–29
|
134
|
83
|
43
|
19
|
79
|
|
30–39
|
221
|
79
|
48
|
25
|
74
|
|
40–49
|
205
|
74
|
58
|
33
|
73
|
|
50–59
|
234
|
72
|
51
|
23
|
80
|
|
60–69
|
315
|
60
|
48
|
23
|
78
|
|
70–79
|
234
|
58
|
35
|
12
|
81
|
|
80+
|
84
|
48
|
27
|
9
|
83
|
|
Region[e]
|
|
Eastern
|
283
|
46
|
37
|
15
|
63
|
|
Western
|
1,208
|
72
|
47
|
23
|
81
|
|
Education
|
|
Less than high school
|
13
|
23
|
23
|
8
|
77
|
|
High school graduate or GED
|
187
|
46
|
25
|
10
|
71
|
|
2-y degree or some college
|
384
|
55
|
40
|
18
|
72
|
|
4-y degree or more
|
838
|
80
|
53
|
27
|
82
|
|
Race and ethnicity
|
|
AIAN alone
|
4
|
25
|
0
|
0
|
50
|
|
Black alone
|
36
|
78
|
39
|
17
|
83
|
|
Asian alone
|
112
|
81
|
49
|
31
|
94
|
|
NHPI alone
|
6
|
67
|
50
|
17
|
67
|
|
Hispanic any race
|
75
|
69
|
44
|
16
|
77
|
|
Two or more races specified
|
60
|
64
|
53
|
23
|
63
|
|
Another race
|
17
|
71
|
41
|
6
|
35
|
|
White alone
|
1,060
|
67
|
46
|
22
|
79
|
|
Gender
|
|
Female
|
813
|
68
|
49
|
23
|
81
|
|
Male
|
563
|
69
|
42
|
22
|
76
|
|
Transgender
|
3
|
67
|
0
|
0
|
100
|
|
Nonbinary/nonconforming
|
5
|
80
|
40
|
20
|
100
|
|
Prefer not to respond
|
44
|
55
|
27
|
0
|
24
|
a Survey Question: In the last 12 months, have you been asked to show proof of COVID-19
vaccination, or a negative COVID-19 test result before participating in an activity
or entering a business?
b Survey Question: Before receiving this survey, had you heard about WA Verify?
c Survey Question: Do you use WA Verify?
d Survey Question: How do you feel about policies that require proof of vaccination
or a negative COVID-19 test result to enter spaces that are high risk of COVID-19
spread?
e Region is determined by county ([Supplemental Fig. S7]).
Regionality of Verification Experiences and Barriers and Facilitators
Respondents living in Eastern and Western WA differed in their experiences surrounding
vaccine verification and concerns with using a public health digital tool like WA
Verify. A larger proportion of those from Western WA reported they had been asked
for proof of COVID-19 vaccine or test in the past 12 months compared with those in
Eastern WA (72.2 vs. 46.2%). Similarly, a greater proportion of those from Western
WA reported having heard of WA Verify before the survey (47.1 vs. 37.2%) and had used
WA Verify or a similar tool (22.9 vs. 15.0%).
Although over three-quarters of respondents (77%) expressed support (“strongly support”
or “support”) for COVID-19 vaccination or testing requirements, the level of support
was greater in Western WA (81%) compared with Eastern WA (63%).
Among respondents who did not report using WA Verify or a similar tool (N = 1,085, 72.8%), 36% reported being willing and 27% reported being somewhat willing
to use a portable COVID-19 vaccine record. Comparing state regions, a larger proportion
of those in Western WA were “willing” or “somewhat willing” to use a portable COVID-19
vaccine record (66 vs. 53%, respectively).
Discussion
The WA Verify statewide survey described here sought to provide an accurate snapshot
of the WA state population, gathering data from a large and representative sample
regarding a specific tool (WA Verify) and digital health tools in general. The survey
found that a majority (66.5%) of respondents had been asked for proof of vaccination
in the past 12 months. Additionally, close to half (44.6%) of respondents had heard
of the WA Verify tool and 20.7% of respondents reported using the tool. While survey
percentages cannot be directly translated into population percentages, these results
suggest that this rapidly deployed tool was quickly adopted by millions of residents
who saw the value in both the tool and the public health policies it supported.
In addition to awareness and adoption of WA Verify, other key findings may help guide
further development of this or similar tools. First, WA Verify adoption varied by
region with 22.9% of Western Washington residents (in the more metropolitan part of
the state) versus 15.0% of Eastern Washington residents reporting use of the tool.
Notably, this difference in adoption is roughly proportional to the difference between
the regions reported needs to present proof of vaccines or a negative test (72.2%
in the West vs. 46.2% in the East). Respondents indicated interest in the tool with
63% of respondents who didn't use WA Verify reporting at least some willingness to
use the tool.
While others have provided system descriptions[7]
[8]
[9] and formative work on perceived acceptability of vaccine verification tools,[11]
[15] the study presented here is one of the few examples of an implemented immunization
verification tool and corresponding comprehensive survey supporting its continued
use and improvement.
The large, population-based survey presented here had many strengths but also had
several limitations. Participation was voluntary and while efforts were made to present
the survey and its questions in a neutral manner, response bias resulting from under
or overrepresentation of certain groups could not be fully accounted for, even with
our weighting strategy. As an example, despite providing a Spanish-language version
of the survey, there were no completed versions of this survey returned, representing
one of many possible forms of nonresponse bias. Opinions on vaccination and public
health policies related to COVID-19 are often influenced by ideological perspectives
and political affiliation. To maintain a neutral tone, the survey did not include
questions in these potentially sensitive areas, limiting our ability to explore these
differences. Additionally, this study was conducted during a period in which interest
in and efforts to mitigate COVID-19 were greater than they are now, meaning the opinions
captured may not reflect current views.
Conclusion
Insights gained from surveys such as the one presented here are invaluable in tailoring
messaging and system design, particularly if data are integrated early in the development
process. As the public health landscape evolves and digital health solutions become
more prevalent, leveraging the insights gained from surveys—such as the one presented
here—will be an important tool for understanding the population of interest and guiding
the practice of public health informatics. As examples, additional analysis and a
set of personas (a user-centered design tool) were developed from the WA Verify survey
data to help guide future public health messaging.[18] Ultimately, this targeted, data-focused strategy not only improves engagement but
also ensures that technological advancements in public health are responsive to the
actual needs and preferences of the communities they aim to serve.
Clinical Relevance Statement
Clinical Relevance Statement
This study highlighted the value of simple random address-based samples for obtaining
representative data on communities or geographic areas; this technique should be considered
as a part of formative evaluation for community-based health informatics projects.
Survey results indicate that the mobile vaccine verification tool deployed in WA state
enjoys broad appeal and acceptance. Regional differences in both public health opinions
and willingness to adopt were also noted and should be considered in informational
and marketing campaigns.
