Continuance of Government-Led COVID-19 Digital Health Applications: A Systematic Literature Review

Government-led digital health applications were rapidly deployed worldwide during the COVID-19 pandemic to support contact tracing, vaccination management, public health surveillance, and risk communication. Although these applications achieved unprecedented adoption under crisis conditions, sustaining continued use beyond emergency mandates remains theoretically underexplored. Existing information systems continuance models were largely developed for voluntary, market-driven technologies and provide limited explanatory power for government-led digital health systems characterised by institutional authority, privacy sensitivity, and crisis governance.
This study conducts a systematic literature review (SLR) to advance theoretical understanding of continuance behaviour in government-led COVID-19 digital health applications. Following PRISMA guidelines, peer-reviewed studies published between 2020 and 2024 were retrieved from Scopus, Web of Science, IEEE Xplore, ScienceDirect, and Google Scholar. Evidence from national applications—including MySejahtera (Malaysia), TraceTogether (Singapore), SwissCovid (Switzerland), and the NHS COVID-19 App (United Kingdom)—was synthesised using a theory-driven analytical approach.
The review identifies three interdependent layers shaping continuance behaviour: system value mechanisms (perceived usefulness, system and information quality), institutional mechanisms (trust in government, privacy protection, governance transparency), and contextual constraint mechanisms (mandates, perceived health risk, and crisis salience). While perceived usefulness and satisfaction remain necessary conditions for continued use, they are insufficient in isolation. Institutional trust and governance legitimacy emerge as central moderators that reshape post-adoption behaviour in public digital health systems. This study extends continuance theory by proposing a multi-layer framework tailored to crisis-driven, government-led digital platforms and provides implications for sustaining digital public health infrastructures beyond emergency contexts.

Digital health; COVID-19 applications

1. Bhattacherjee, A. (2001). Understanding information systems continuance: An expectation-confirmation model. MIS Quarterly, 25(3), 351–370. [Google Scholar] [Crossref]

2. DeLone, W. H., & McLean, E. R. (2003). The DeLone and McLean model of information systems success: A ten-year update. Journal of Management Information Systems, 19(4), 9–30. [Google Scholar] [Crossref]

3. Samsuri, A. S., Hussin, S. M., Badaruddin, M. N. A., et al. (2022). Antecedents of user satisfaction and continuance usage of mobile health applications: A study on MySejahtera. Asian Journal of Behavioural Sciences, 4(2), 91–105. [Google Scholar] [Crossref]

4. Jaffar, A., et al. (2021). Evaluating usability and acceptability of a mobile health intervention. International Journal of Medical Informatics, 148, 104392. [Google Scholar] [Crossref]

5. Tomczyk, S., et al. (2021). Predicting adoption of COVID-19 contact tracing apps. Journal of Medical Internet Research, 23(5), e25447. [Google Scholar] [Crossref]

6. von Wyl, V., et al. (2021). Drivers of acceptance of COVID-19 proximity tracing apps. JMIR Public Health and Surveillance, 7(1), e25701. [Google Scholar] [Crossref]

7. Munzert, S., et al. (2021). Tracking and promoting the usage of COVID-19 contact tracing apps. Political Science Research and Methods, 9(4), 1–17. [Google Scholar] [Crossref]

8. Walrave, M., Waeterloos, C., & Ponnet, K. (2020). Adoption of a contact tracing app. JMIR Public Health and Surveillance, 6(3), e20572. [Google Scholar] [Crossref]

9. Whitelaw, S., et al. (2020). Applications of digital technology in COVID-19 response. The Lancet Digital Health, 2(8), e435–e440. [Google Scholar] [Crossref]

• Migrant Health in Morocco: Between Law and Reality
• CaknaMinda: An Educator-Centred Mobile App for Early Screening of Mental Health and Schizophrenia Risks
• Health System and Nursing Strategies for Enhancing Male Participation in Family Planning: Evidence from Tema General Hospital, Ghana.
• From Īśvara-Praṇidhāna to Parā-Bhakti: Convergent Paths of Aṣṭāṅga Yoga and Bhakti Yoga
• Evidence-Based Psycho-Oncological Interventions: A Multimodal Approach to Supportive Care