FluWatchers: Evaluation of a crowdsourced influenza-like illness surveillance application for Canadian influenza seasons 2015-2016 to 2018-2019.

Background: Sentinel influenza-like illness (ILI) surveillance is an essential component of a comprehensive influenza surveillance program. Community-based ILI surveillance systems that rely solely on sentinel healthcare practices omit important segments of the population, including those who do not seek medical care. Participatory surveillance, which relies on community participation in surveillance, may address some limitations of traditional ILI systems.

Objective: We aimed to evaluate FluWatchers, a crowdsourced ILI application developed to complement and complete ILI surveillance in Canada.

Methods: Using established frameworks for surveillance evaluations, we assessed the acceptability, reliability, accuracy and usefulness of the FluWatchers system 2015-2016, through 2018-2019. Evaluation indicators were compared against national surveillance indicators of ILI and of laboratory confirmed respiratory virus infections.

Results: The acceptability of FluWatchers was demonstrated by growth of 50%-100% in season-over-season participation, and a consistent season-over-season retention of 80%. Reliability was greater for FluWatchers than for our traditional ILI system, although both systems had week-over-week fluctuations in the number of participants responding. FluWatchers' ILI rates had moderate correlation with weekly influenza laboratory detection rates and other winter seasonal respiratory virus detections including respiratory syncytial virus and seasonal coronaviruses. Finally, FluWatchers has demonstrated its usefulness as a source of core FluWatch surveillance information and has the potential to fill data gaps in current programs for influenza surveillance and control.

Conclusion: FluWatchers is an example of an innovative digital participatory surveillance program that was created to address limitations of traditional ILI surveillance in Canada. It fulfills the surveillance system evaluation criteria of acceptability, reliability, accuracy and usefulness.