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

Abstract

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.