Studying Users' Perceptions of COVID-19 Mobile Applications in Saudi Arabia

In Saudi Arabia, several mitigating measures were implemented in response to the COVID-19 pandemic, including the creation of COVID-19 mobile applications (apps) for public use. The Saudi government has made the use of these apps mandatory for its citizens and residents. However, it is essential to explore the perception that common users have regarding using these apps in terms of usability and user experience. Therefore, this paper assesses user experience in terms of effectiveness, efficiency, and user satisfaction with the usability of the Saudi COVID-19 apps. The reviews of five mobile apps launched by the Saudi Data and AI Authority (SDAIA) and the Ministry of Health in the Apple Store were extracted using an online tool and analyzed using the content analysis method. The number of collected reviews was 29 for Sehha, 406 for Sehhaty, 442 for Mawid, 107 for Tabaud, and 1338 for Tawakkalna. The results of the study showed that Mawid (82%) and Tabaud (81%) had the highest usability of all the apps studied. Sehha (-138%) and Sehhaty (-107%) received the lowest usability scores, followed by Tawakkalna (-22%). Based on these results, we identified several usability issues with each app. Some of the main problems reported by users were increased battery drain, lack of privacy, and technical issues.

Paying for Digital Health Interventions - What Evidence is Needed?

Digital health has accelerated, in part, due to the recent COVID-19 pandemic in terms of both implementation and acceptability. However, while digitalization in healthcare brings an opportunity to improve the quality of care, this creates a need for sustainability through funding of these technologies by healthcare payers. Traditional innovations such as pharmaceuticals are rigorously evaluated by health technology assessment (HTA) bodies in many countries to advise payers on how scarce funds can be efficiently distributed. The aim of this study was to review the HTA evidence frameworks being applied by HTA bodies or payers for the evaluation of digital health interventions. We reviewed recent literature and the websites of the leading payer and HTA bodies to understand the frameworks which have been used for the evaluation of digital health innovations. We found that 6 frameworks directly addressed digital health technologies for the purposes of pricing and reimbursement. Building on previous work, we reviewed the context and evidence domains of each framework. The evidence requirements of the included frameworks were diverse, and their domains extended the European Network for Health Technology Assessment (EUnetHTA) Core HTA Model. Our research concluded that while some frameworks exist, they require additional refinement to ensure that the level of evidence is commensurate with the technology being assessed and that relevant stakeholders are included to more holistically assess the outcomes produced. Developers of digital health technologies need to be aware of the evidence requirements by payers or HTA bodies, which differ from HTA requirements for traditional health technologies and may represent additional hurdle before entering publicly financed healthcare markets.

Recruiting Military Veterans into Alcohol Misuse Research: The Role of Social Media and Facebook Advertising

Background: The use of digital technology within health care service delivery, monitoring, and research is becoming progressively popular, particularly given the ongoing COVID-19 pandemic. Mobile health (m-health) apps, one form of digital technology, are increasingly being used to promote positive health related behavior change. Therefore, it is important to conduct research to understand the efficacy of m-health apps. The process of participant recruitment is an essential component in producing strong research evidence, along with ensuring an adequately powered sample to conduct meaningful analyses and draw robust conclusions. Methods: In this work we outline and reflect on the strategies used to recruit help-seeking military veterans into an intervention study, which aimed to evaluate the efficacy of an app (Drinks:Ration) to modify behavior in alcohol misusers. Recruitment strategies included through (1) partner organizations and (2) social media and Facebook advertising (ads). Results: Facebook ads were live for a period of 88 days and were viewed by a total audience of 29,416 people. In total 168 military veterans were recruited across all recruitment strategies, meaning that Drinks:Ration exceeded its recruitment targets. Half of the sample (n = 84) were recruited through social media, including Facebook ads. Conclusions: The current article highlighted that targeted Facebook ads were an efficient strategy to recruit military veterans into a digital intervention trial aiming to reduce alcohol consumption because they reduced the amount of time and resources required to contact a large number of potentially eligible individuals for our study. This article acts as a starting point for other researchers to evaluate their recruitment pathways for recruiting military veterans into alcohol misuse research. © Copyright 2023, Mary Ann Liebert, Inc., publishers 2023.

An mHealth Intervention to Reduce Gestational Obesity (mami-educ): Protocol for a Randomized Controlled Trial.

BACKGROUND: The World Federation of Obesity warns that the main health problem of the next decade will be childhood obesity. It is known that factors such as gestational obesity produce profound effects on fetal programming and are strong predictors of overweight and obesity in children. Therefore, establishing healthy eating behaviors during pregnancy is the key to the primary prevention of the intergenerational transmission of obesity. Mobile health (mHealth) programs are potentially more effective than face-to-face interventions, especially during a public health emergency such as the COVID-19 outbreak. OBJECTIVE: This study aims to evaluate the effectiveness of an mHealth intervention to reduce excessive weight gain in pregnant women who attend family health care centers. METHODS: The design of the intervention corresponds to a classic randomized clinical trial. The participants are pregnant women in the first trimester of pregnancy who live in urban and semiurban areas. Before starting the intervention, a survey will be applied to identify the barriers and facilitators perceived by pregnant women to adopt healthy eating behaviors. The dietary intake will be estimated in the same way. The intervention will last for 12 weeks and consists of sending messages through a multimedia messaging service with food education, addressing the 3 domains of learning (cognitive, affective, and psychomotor). Descriptive statistics will be used to analyze the demographic, socioeconomic, and obstetric characteristics of the respondents. The analysis strategy follows the intention-to-treat principle. Logistic regression analysis will be used to compare the intervention with routine care on maternal pregnancy outcome and perinatal outcome. RESULTS: The recruitment of study participants began in May 2022 and will end in May 2023. Results include the effectiveness of the intervention in reducing the incidence of excessive gestational weight gain. We also will examine the maternal-fetal outcome as well as the barriers and facilitators that influence the weight gain of pregnant women. CONCLUSIONS: Data from this effectiveness trial will determine whether mami-educ successfully reduces rates of excessive weight gain during pregnancy. If successful, the findings of this study will generate knowledge to design and implement personalized prevention strategies for gestational obesity that can be included in routine primary care. TRIAL REGISTRATION: ClinicalTrials.gov NCT05114174; https://clinicaltrials.gov/ct2/show/NCT05114174. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44456.

Essential elements of weight loss apps for a multi-ethnic population with high BMI: a qualitative study with practical recommendations.

Smartphone weight loss apps are constantly being developed but the essential elements needed by a multi-ethnic population with overweight and obesity remains unclear. Purpose: To explore the perceptions of an Asian multi-ethnic population with overweight and obesity on the essential elements of weight loss apps. Twenty two participants were purposively sampled from a specialist weight management clinic in Singapore from 13 April to 30 April 2021. Recorded interviews were conducted using face-to-face and videoconferencing modalities. Data saturation was reached at the 18th participant. Data analysis was performed using inductive content analysis with constant comparison between and within transcripts. Findings: Three themes and eight subthemes on the essential app components emerged-(a) comprehensive and flexible calorie counters; (b) holistic, gradual and individualized behavior change recommendations tailored for people with overweight and obesity, and (c) just-in-time reminders of future consequences. There was a need to incorporate flexible options for food logging; break down general recommendations into small steps towards sustainable changes; tailor app contents for people with overweight and obesity; and evoke one's considerations of future consequences. Future weight loss apps should be designed to meet the needs of those with overweight and obesity, the very population that needs assistance with weight loss. Future apps could consider leveraging the capacity of artificial intelligence to provide personalized weight management in terms of sustaining self-regulation behaviors, optimizing goal-setting and providing personalized and timely recommendations for weight loss.

Weight loss smartphone apps are ubiquitous but the essential elements needed and preferred by people with overweight and obesity remains unclear. Therefore, we conducted a qualitative study to explore the perceptions and needs of this population in a weight loss app to prolong app engagement and enhance weight loss success. 22 participants were interviewed through face-to-face or videoconferencing sessions during the peak of the COVID-19 pandemic. Interview transcripts were analyzed within and between participants to develop codes, subthemes and themes that represent the participants' perceptions and needs in weight loss apps. Participants expressed the need for (a) comprehensive and flexible calorie counters; (b) holistic, gradual, and individualized behavior change recommendations tailored for people with overweight and obesity; and (c) just-in-time reminders of future consequences. Our findings showed a need to incorporate flexible options for food logging; break down general recommendations into small steps towards sustainable changes; tailor app contents for people with overweight and obesity; and evoke one's considerations of future consequences. Future apps could consider leveraging the capacity of artificial intelligence to provide personalized weight management in terms of sustaining self-regulation behaviors, optimizing goal-setting and providing personalized and timely recommendations for weight loss.

Design and Implementation of a Mobile Health Check Device

The mobile health check device is an IoT based system that has been designed to play a vital role in checking people's health status. It has become very crucial to monitor people's health especially now with this COVID-19 pandemic. Through this device it will be possible for people to check for blood oxygen levels, temperature, blood pressure and heart beat rate without the use of sphygmomanometers at health care centres. Furthermore, the device is not only limited to COVID-19 symptoms detection, but it can also be used for monitoring pneumonia, asthma and other common critical conditions related to the stated parameters. The results of the device are displayed on an LCD screen and also sent to the cloud servers for storage and record keeping. The mobile device proofs to be a quick health screening device for different organisations and at different public places such as at airports, borders, shopping malls, industries, religious centres and educational institutions. © 2022 IEEE.

A Friendly Interface Medical Service Robot with Fault-tolerant Voice Recognition and Mobile Phone Remote Control

In recent years, due to the impact of COVID-19 around the world, there has been a serious shortage of medical resources. In order to supplement the manpower and fear that medical staff's contact with patients will cause a breach in the epidemic, reduce the workload of nurses, and help nurses perform repetitive tasks so that nurses can concentrate more on the patient's condition. Therefore, this paper proposes M-Robot, which is a friendly interface service robot based on the Android system and can be controlled by voice, touch, and remote control in the medical care field. The system is mainly divided into two parts. One is the web server. The web server is divided into two parts: front-end and back-end. The front-end is responsible for friendly user interface management, and the back-end is for accessing the SQLite database, as well as processing speech recognition and semantic understanding in voice services. In the other part, we use TEMI robot to develop and complete the desired service. Its service content includes environment introduction, delivery service, questionnaire survey, broadcast car, scheduling reminder, follow-up record, and patient instruction video. In the voice control mode, the user can say the wake-up word to the robot and say the required service content, and the robot will execute after receiving the message;in the remote control mode, we provide a friendly web interface for remote control. As well as the information needed to manage various services. © 2022 IEEE.

Willingness to Use Mobile Health Devices in the Post-COVID-19 Era: Nationwide Cross-sectional Study in China.

BACKGROUND: Despite the increased development and use of mobile health (mHealth) devices during the COVID-19 pandemic, there is little knowledge of willingness of the Chinese people to use mHealth devices and the key factors associated with their use in the post-COVID-19 era. Therefore, a more comprehensive and multiangle investigation is required. OBJECTIVE: We aimed to probe Chinese attitudes regarding the use of mHealth and analyze possible associations between the attitude of willingness to use mHealth devices and some factors based on the socioecological model. METHODS: A survey was conducted using quota sampling to recruit participants from 148 cities in China between June 20 and August 31, 2022. Data from the survey were analyzed using multiple stepwise regression to examine the factors associated with willingness to use mHealth devices. Standardized regression coefficients (ß) and 95% CIs were calculated using multiple stepwise regression. RESULTS: The survey contained a collection of 21,916 questionnaires and 21,897 were valid questionnaires, with a 99.91% effective response rate. The median score of willingness to use mHealth in the post-COVID-19 era was 70 points on a scale from 0 to 100. Multiple stepwise regression results showed that the female gender (ß=.03, 95% CI 1.04-2.35), openness personality trait (ß=.05, 95% CI 0.53-0.96), higher household per capita monthly income (ß=.03, 95% CI 0.77-2.24), and commercial and multiple insurance (ß=.04, 95% CI 1.77-3.47) were factors associated with the willingness to use mHealth devices. In addition, people with high scores of health literacy (ß=.13, 95% CI 0.53-0.68), self-reported health rating (ß=.22, 95% CI 0.24-0.27), social support (ß=.08, 95% CI 0.40-0.61), family health (ß=.03, 95% CI 0.03-0.16), neighbor relations (ß=.12, 95% CI 2.09-2.63), and family social status (ß=.07, 95% CI 1.19-1.69) were more likely to use mHealth devices. CONCLUSIONS: On the basis of the theoretical framework of socioecological model, this study identified factors specifically associated with willingness of the Chinese people to use mHealth devices in the post-COVID-19 era. These findings provide reference information for the research, development, promotion, and application of future mHealth devices.

The Electronic Mental Wellness Tool as a Self-Administered Brief Screening Instrument for Mental Disorders in the General Spanish Population during the Post-COVID-19 Era.

(1) Background: In the "post-COVID-19 era", there is a need to focus on properly assessing and addressing the extent of its well-established mental health collateral damage. The "Electronic Mental Wellness Tool" (E-mwTool) is a 13-item validated stepped-care or stratified management instrument that aims at the high-sensitivity captures of individuals with mental health disorders to determine the need for mental health care. This study validated the E-mwTool in a Spanish-speaking population. (2) Methods: It is a cross-sectional validation study using the Mini International Neuropsychiatric Interview as a criterion standard in a sample of 433 participants. (3) Results: About 72% of the sample had a psychiatric disorder, and 67% had a common mental disorder. Severe mental disorders, alcohol use disorders, substance use disorders, and suicide risk had a much lower prevalence rate (6.7%, 6.2%, 3.2%, and 6.2%, respectively). The first three items performed excellently in identifying any mental health disorder with 0.97 sensitivity. Ten additional items classified participants with common mental disorders, severe mental disorders, substance use disorders, and suicide risk. (4) Conclusions: The E-mwTool had high sensitivity in identifying common mental disorders, alcohol and substance use disorders, and suicidal risk. However, the tool's sensitivity in detecting low-prevalence disorders in the sample was low. This Spanish version may be useful to detect patients at risk of mental health burden at the front line of primary and secondary care in facilitating help-seeking and referral by their physicians.

Evidence of mobile health integration into primary health care systems for better maternal mental health in LMICs during COVID-19 pandemic - Review.

Mental illnesses are prevalent worldwide, especially in the underdeveloped countries of the South Asian region, particularly in women, where they largely remain unaddressed. Evidence from the South Asian region indicates that there is a high burden of mental disorders in vulnerable populations such as pregnant women. Mental health problems during pregnancy and in the postpartum period are twice as common in LMICs as compared to HICs. Interventions delivered by community health workers (CHWs) in many health delivery and promotive initiatives have played a vital role in improving mental health. CHW-based interventions are cost-effective, efficient and acceptable for the local people and can strengthen the overall health system. This review aimed to explore integration of maternal mental health into existing maternal, newborn and child health (MNCH) programs so that delivery of mental health interventions can be done alongside MNCH interventions. Integrating maternal mental health programmes into existing MNCH programs and using digital platforms for expanding their delivery through CHWs, lay counsellors, and other frontline health workers can prove to be a promising strategy. Even though mHealth platforms for addressing a variety of health issues have been widely used during the COVID-19 pandemic, the use of digital platforms for addressing maternal mental health issues remains inadequate.

Masibambane-Ladies Chat: Developing an Online Gender-Enhanced PrEP Information-Motivation Workshop for Young South African Women.

This article describes the processes of transforming an in-person group-based intervention to promote uptake of PrEP among young woman in South Africa to an online interactive "workshop" during the COVID-19 pandemic. Beginning in person and continuing virtually, we used a step-by-step participatory approach with multiple stakeholder groups to develop nine activities to increase knowledge about, as well as motivation and intention to take PrEP, and to address gender-based barriers to PrEP. Activities were informed by our theoretical framework and formative work with young women ages 18-25. We demonstrate how we developed a gender-enhanced online PrEP workshop that was interactive, group-based, and in accordance with elements of established successful intervention design; why WhatsApp emerged as the most accessible application for the young women in our workshop; and how an intervention with a hybrid approach-alternating between chat box and live sessions-combined with verbal, written, and emoji-based communication enabled interaction among participants.

SMS-based digital health intervention in Rwanda's home-based care program for remote management of COVID-19 cases and contacts: A qualitative study of sustainability and scalability.

Background: COVID-19 pandemic resulted in unprecedented global health challenges. Rwanda identified its first COVID-19 case on March 14, 2020 and subsequently introduced Home-Base Care (HBC) Program in August 2020 following community transmission of the virus and to alleviate logistical and financial strain on the healthcare system. Cases and contacts eligible for HBC were remotely supported by WelTel, an SMS-based mHealth intervention that was successfully implemented before for HIV epidemic in Rwanda. Enrolled cases and contacts were supported and monitored daily via their cell and/or mobile phones until they complete isolation/quarantine period. This study explored the rationale, perspectives, and experiences of key informants (KIs) during the implementation WelTel's mHealth tool for HBC in Rwanda. Methods: Semi-structured one-on-one virtual interviews were conducted with KIs in this qualitative study. The KIs were classified into 2 major categories: (A) Senior staff including policymakers, directors, and senior managers; (B) Technical teams including case managers, and other staff supporting the implementation of WelTel (e.g., IT staff). Interviews were audio-recorded, transcribed, and analyzed in NVivo. Thematic analysis was conducted using a hybrid approach. A topic guide was developed using the Modified Consolidated Framework for Implementation Research and feedback from local stakeholders. Results: 7 KIs were interviewed. Five themes emerged following thematic analysis including: SMS-Based mHealth for Home-Isolation; Facilitators for Intervention Adoption; Barriers for Intervention Adoption; Infection prevention and control for Home-Isolation; and SMS-Based mHealth for Future Pandemics and Epidemics. Based on interviews, strong political commitment and advanced digital infrastructure were major facilitators for adopting WelTel for HBC. A major barrier to adopting WelTel was identified as technical-based issues. This was followed by local communication culture. All participates agreed on the significance of using WelTel to improve access and adherence to infection prevention and control measures, understand transmission dynamics, and inform public health decision-making regarding HBC. Conclusions: Rwanda successfully adopted WelTel for supporting and monitoring COVID-19 cases and contacts in home-isolation and the implementation was instrumental to the country's effort to manage the pandemic. Experiences and perspectives of cases and contacts enrolled into WelTel must be explored to understand the appropriateness and effectiveness of the intervention.

Investigating Popular Mental Health Mobile Application Downloads and Activity During the COVID-19 Pandemic.

OBJECTIVE: This article analyzes the changes in downloads and activity of users of select popular mental health mobile applications (mHealth apps) during coronavirus disease 2019 (COVID-19). BACKGROUND: The outbreak of the COVID-19 crisis has shown a negative impact on public mental health. Mobile health has the potential to help address the psychological needs of existing and new patients during the pandemic and beyond. METHOD: Downloads data of 16 widely used apps were analyzed. The quality of apps was reviewed using the Mobile Application Rating Scale (MARS) framework. Correlation analysis was conducted to investigate the relationship between app quality and app popularity. RESULTS: Among the 16 apps, 10 were meditational in nature, 13 showed increased downloads, with 11 apps showing above 10% increase in the downloads after the pandemic started. The popular apps were satisfactory in terms of functionality and esthetics but lacked clinical grounding and evidence base. There exists a gap between app quality and app popularity. CONCLUSION: This study provided evidence for increased downloads of mental mHealth apps (primarily meditation apps) during the COVID-19 pandemic but revealed several gaps and opportunities to address deficiencies in evidence-based design, usability and effective assessment, and integration into current workflows. APPLICATION: The COVID-19 pandemic is a potential turning point for mHealth applications for mental health care. Whereas the evidence suggests a need for alternative delivery of care, human factors and ergonomics methods should be utilized to ensure these tools are user-centered, easy to use, evidence-based, well-integrated with professional care, and used sustainably.

Understanding Use Intention of mHealth Applications Based on the Unified Theory of Acceptance and Use of Technology 2 (UTAUT-2) Model in China.

The COVID-19 pandemic has significantly impacted the healthcare industry, especially public health resources and resource allocation. With the change in people's lifestyles and increased demand for medical and health care in the post-pandemic era, the Internet and home healthcare have rapidly developed. As an essential part of Internet healthcare, mobile health (mHealth) applications help to fundamentally address the lack of medical resources and meet people's healthcare needs. In this mixed-method study, we conducted in-depth interviews with 20 users in China (mean age = 26.13, SD = 2.80, all born in China) during the pandemic, based on the unified theory of acceptance and use of technology 2 (UTAUT-2) mode, and identified four dimensions of user needs in mHealth scenarios: convenience, control, trust, and emotionality. Based on the interview results, we adjusted the independent variables, deleted the hedonic motivation and the habit, and added the perceived trust and perceived risk as the variables. Using a structural equation model (SEM), we designed the questionnaire according to the qualitative results and collected data from 371 participants (above 18 years old, 43.9% male) online to examine the interrelationships these variables. The results show that performance expectancy (ß = 0.40, p < 0.001), effort expectancy (ß = 0.40, p < 0.001), social influence (ß = 0.14, p < 0.05), facilitating condition (ß = 0.15, p < 0.001), and perceived trust (ß = 0.31, p < 0.001) had positive effects on use intention. Perceived risk (ß = -0.31, p < 0.001) harmed use intention, and price value (ß = 0.10, p > 0.5) had no significant effects on use intention. Finally, we discussed design and development guidelines that can enhance user experience of mHealth applications. This research combines the actual needs and the main factors affecting the use intention of users, solves the problems of low satisfaction of user experience, and provides better strategic suggestions for developing mHealth applications in the future.

An empirical investigation into the altering health perspectives in the internet of health things.

Healthcare is on top of the agenda of all governments in the world as it is related to the well-being of the people. Naturally, this domain has attracted the attention of many researchers globally, who have studied the development of its different phases, including E-Health and the Internet of Health Things (IoHT). In this paper, the difference between the recent concepts of healthcare (E-health, M-Health, S-Health, I-Health, U-Health, and IoHT/IoMT) is analyzed based on the main services, applications, and technologies in each concept. The paper has also studied the latest developments in IoHT, which are linked to existing phases of development. A classification of groups of services and constituents of IoHT, linked to the latest technologies, is also provided. In addition, challenges, and future scope of research in this domain concerning the wellbeing of the people in the face of ongoing COVID-19 and future pandemics are explored.

Willingness to Use Mobile Health Devices in the Post-COVID-19 Era: Nationwide Cross-sectional Study in China.

BACKGROUND: Despite the increased development and use of mobile health (mHealth) devices during the COVID-19 pandemic, there is little knowledge of willingness of the Chinese people to use mHealth devices and the key factors associated with their use in the post-COVID-19 era. Therefore, a more comprehensive and multiangle investigation is required. OBJECTIVE: We aimed to probe Chinese attitudes regarding the use of mHealth and analyze possible associations between the attitude of willingness to use mHealth devices and some factors based on the socioecological model. METHODS: A survey was conducted using quota sampling to recruit participants from 148 cities in China between June 20 and August 31, 2022. Data from the survey were analyzed using multiple stepwise regression to examine the factors associated with willingness to use mHealth devices. Standardized regression coefficients (ß) and 95% CIs were calculated using multiple stepwise regression. RESULTS: The survey contained a collection of 21,916 questionnaires and 21,897 were valid questionnaires, with a 99.91% effective response rate. The median score of willingness to use mHealth in the post-COVID-19 era was 70 points on a scale from 0 to 100. Multiple stepwise regression results showed that the female gender (ß=.03, 95% CI 1.04-2.35), openness personality trait (ß=.05, 95% CI 0.53-0.96), higher household per capita monthly income (ß=.03, 95% CI 0.77-2.24), and commercial and multiple insurance (ß=.04, 95% CI 1.77-3.47) were factors associated with the willingness to use mHealth devices. In addition, people with high scores of health literacy (ß=.13, 95% CI 0.53-0.68), self-reported health rating (ß=.22, 95% CI 0.24-0.27), social support (ß=.08, 95% CI 0.40-0.61), family health (ß=.03, 95% CI 0.03-0.16), neighbor relations (ß=.12, 95% CI 2.09-2.63), and family social status (ß=.07, 95% CI 1.19-1.69) were more likely to use mHealth devices. CONCLUSIONS: On the basis of the theoretical framework of socioecological model, this study identified factors specifically associated with willingness of the Chinese people to use mHealth devices in the post-COVID-19 era. These findings provide reference information for the research, development, promotion, and application of future mHealth devices.

Voice Assistants' Responses to Questions About the COVID-19 Vaccine: National Cross-sectional Study.

BACKGROUND: Artificial intelligence-powered voice assistants (VAs), such as Apple Siri, Google Assistant, and Amazon Alexa, interact with users in natural language and are capable of responding to simple commands, searching the internet, and answering questions. Despite being an increasingly popular way for the public to access health information, VAs could be a source of ambiguous or potentially biased information. OBJECTIVE: In response to the ongoing prevalence of vaccine misinformation and disinformation, this study aims to evaluate how smartphone VAs respond to information- and recommendation-seeking inquiries regarding the COVID-19 vaccine. METHODS: A national cross-sectional survey of English-speaking adults who owned a smartphone with a VA installed was conducted online from April 22 to 28, 2021. The primary outcomes were the VAs' responses to 2 questions: "Should I get the COVID vaccine?" and "Is the COVID vaccine safe?" Directed content analysis was used to assign a negative, neutral, or positive connotation to each response and website title provided by the VAs. Statistical significance was assessed using the t test (parametric) or Mann-Whitney U (nonparametric) test for continuous variables and the chi-square or Fisher exact test for categorical variables. RESULTS: Of the 466 survey respondents included in the final analysis, 404 (86.7%) used Apple Siri, 53 (11.4%) used Google Assistant, and 9 (1.9%) used Amazon Alexa. In response to the question "Is the COVID vaccine safe?" 419 (89.9%) users received a direct response, of which 408 (97.3%) had a positive connotation encouraging users to get vaccinated. Of the websites presented, only 5.3% (11/207) had a positive connotation and 94.7% (196/207) had a neutral connotation. In response to the question "Should I get the COVID vaccine?" 93.1% (434/466) of users received a list of websites, of which 91.5% (1155/1262) had a neutral connotation. For both COVID-19 vaccine-related questions, there was no association between the connotation of a response and the age, gender, zip code, race or ethnicity, and education level of the respondent. CONCLUSIONS: Our study found that VAs were much more likely to respond directly with positive connotations to the question "Is the COVID vaccine safe?" but not respond directly and provide a list of websites with neutral connotations to the question "Should I get the COVID vaccine?" To our knowledge, this is the first study to evaluate how VAs respond to both information- and recommendation-seeking inquiries regarding the COVID-19 vaccine. These findings add to our growing understanding of both the opportunities and pitfalls of VAs in supporting public health information dissemination.