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Physical inactivity and sedentary behavior increase the risk of chronic illness and death. The newest generation of “wearable” activity trackers offers potential as a multifaceted intervention to help people become more active.
To examine the usability and usefulness of wearable activity trackers for older adults living with chronic illness.
We recruited a purposive sample of 32 participants over the age of 50, who had been previously diagnosed with a chronic illness, including vascular disease, diabetes, arthritis, and osteoporosis. Participants were between 52 and 84 years of age (mean 64); among the study participants, 23 (72%) were women and the mean body mass index was 31 kg/m2. Participants tested 5 trackers, including a simple pedometer (Sportline or Mio) followed by 4 wearable activity trackers (Fitbit Zip, Misfit Shine, Jawbone Up 24, and Withings Pulse) in random order. Selected devices represented the range of wearable products and features available on the Canadian market in 2014. Participants wore each device for at least 3 days and evaluated it using a questionnaire developed from the Technology Acceptance Model. We used focus groups to explore participant experiences and a thematic analysis approach to data collection and analysis.
Our study resulted in 4 themes: (1) adoption within a comfort zone; (2) self-awareness and goal setting; (3) purposes of data tracking; and (4) future of wearable activity trackers as health care devices. Prior to enrolling, few participants were aware of wearable activity trackers. Most also had been asked by a physician to exercise more and cited this as a motivation for testing the devices. None of the participants planned to purchase the simple pedometer after the study, citing poor accuracy and data loss, whereas 73% (N=32) planned to purchase a wearable activity tracker. Preferences varied but 50% felt they would buy a Fitbit and 42% felt they would buy a Misfit, Jawbone, or Withings. The simple pedometer had a mean acceptance score of 56/95 compared with 63 for the Withings, 65 for the Misfit and Jawbone, and 68 for the Fitbit. To improve usability, older users may benefit from devices that have better compatibility with personal computers or less-expensive Android mobile phones and tablets, and have comprehensive paper-based user manuals and apps that interpret user data.
For older adults living with chronic illness, wearable activity trackers are perceived as useful and acceptable. New users may need support to both set up the device and learn how to interpret their data.
Physical activity levels often decline with age and over two thirds of adults over the age of 60 sit for more than 8.5 hours of their waking day [
Home-based physical activity programs have significant potential for encouraging physical activity in older adults [
The main challenge to implementing many of the evidence-based physical activity interventions and behavior change techniques is that they are resource intensive. In most cases, often multiple individuals are required to create tailored programs for individual patients, provide education, and then follow-up to promote adherence [
Wearable activity trackers are a rapidly growing health-focused industry. There are many terms for the trackers, including
The newest generation of pedometer is known as the wearable activity tracker. Similar to the behavioral strategies used in walking programs, the new trackers promote goal setting, self-efficacy, and tailored feedback through companion mobile apps and websites. The trackers do this by providing visual representations of activity data (step counts, altimetry, calories, sleep) over days and weeks. Some wearable activity trackers can also be used with social networking sites and other lifestyle apps for diet and stress, such as MyFitnessPal, Weight Watchers, and SparkPeople.
Although the new trackers have been designed as wellness devices rather than health or medical devices, they have considerable potential for use in health care. The BodyMedia FIT and Fitbit Zip trackers have been shown to provide valid measures of daily energy expenditures [
The following conditions are necessary for persuasive technology to promote a behavior: motivation, physical ability, and an effective trigger [
Research has been emerging on the design and evaluation of persuasive technologies to promote physical activity. A matched case-control study with individuals who were members of the 10,000 steps Australia program found that individuals invited to use a website or mobile phone app were four times more likely to log their steps and 20 times more likely to achieve 10,000 daily steps [
Wearable trackers have been increasingly identified as a tool for helping consumers prevent disease and increase physical activity [
Emerging research into persuasive technology and wearable trackers offers significant promise for improving health and fitness. Research into better understanding how their design affects activity and behavior, how visualization helps both motivate and provide awareness, and how feedback can be better understood and used is a growing field [
To date we know little about how older adults perceive new and emerging mobile health (mHealth) tools that include wearable activity trackers. While some studies conclude that health interventions that use technology are less effective than in-person interventions, there is limited evidence to support this conclusion [
Our research design was inspired by a similar study on mobile medication management apps [
We made the following assumptions: (1) most older adults are not using wearable activity trackers; (2) many have chronic illnesses that would benefit from increased physical activity; (3) wearable technologies have the potential to improve activity levels; and (4) there are age-related barriers unique to older users. We also assumed that most older adults are not early adopters and we were therefore asking participants to assume the early adopter role for the duration of this study.
To assess acceptability of commercially available wearable activity trackers, we began by identifying all devices available to Canadian consumers as of November 1, 2013. We identified and reviewed 4 devices by Fitbit, 2 devices by Jawbone, and 1 device each from Withings, Misfit, and Nike. The research team selected 4 devices for testing purpose, with each device representing a different feature available with activity trackers (
We recruited individuals from local public libraries, community centers, and primary care clinics. We also posted information on community message boards and approached the organizers of public programs (eg, Active Seniors at the Kitchener Public Library) to allow us to make brief presentations at events targeting individuals over the age of 50. The participant characteristics are presented in
Comparison of the available features of wearable activity tracker devices assessed between January 1, 2014, and May 31, 2014.
|
Fitbit Zip | Jawbone Up 24 | Misfit Shine | Withings Pulse |
Pedometer (steps) | X | X | X | X |
Altimeter (stairs) |
|
|
|
X |
Waterproof |
|
|
X |
|
Heart rate |
|
|
|
X |
Displays number of steps taken on device | X |
|
|
X |
Displays proportion of steps taken toward the total goal |
|
|
X |
|
Default activity goal | 10,000 steps | 10,000 steps | 1000 points (equivalent to 10,000 steps) | 10,000 steps |
Notifies the user of every 2000 steps |
|
X |
|
|
Cost | US $60 | US $150 | US $130 | US $100 |
Apple iOS | X | X | X | X |
Android | X | Xa | X | X |
aMade available March 2014.
Participants started by using a basic pedometer for 3 days. Participants were then provided 4 wearable activity trackers (Fitbit Zip, Jawbone Up 24, Misfit Shine, and Withings Pulse) in random order and were asked to use each device for at least 3 days. Participants received each new device from investigators and we assisted them in setting the device up if needed. Participants were not required to own their own mobile phone or tablet. A total of 12 participants did not own a mobile phone or tablet, and they were lent one from the investigators or shared one with a friend or family member. Participants were instructed to wear the activity tracker as intended by the manufacturer (eg, Fitbit Zip during waking hours, whereas Jawbone Up 24 during waking and sleeping hours). Participants were asked to synchronize the device and their tablet or mobile phone at least once during each trial period and were expected to record their data, specifically the number of steps captured each day. The purpose of collecting step count data was to ensure that participants could access the information rather than to assess the impact of the devices on their activity levels.
Prior to testing any devices, a researcher measured each participant’s weight, height, resting heart rate, and blood pressure. Participants completed a paper-based questionnaire on demographics and computer experience. Participants self-reported their physical activity using the validated Short Form International Physical Activity Questionnaire, which assesses the duration and frequency of walking, moderate activity, and vigorous activity among adults [
After testing each device, participants completed a questionnaire to describe how they used the device, how satisfied they were with the device, whether or not they would purchase a device, and then rated the devices with a 17-item questionnaire developed using the TAM, which assesses the domains of external variables, perceived usefulness, perceived ease of use, attitude toward using, behavioral intention to use, and actual system use (
Participant characteristicsa (N=32).
Characteristic |
|
Number (% or range) |
Age |
|
64 (52-84) |
|
|
|
|
Male | 9 (28) |
|
Female | 23 (72) |
|
|
|
|
High cholesterol | 10 (31) |
|
High blood pressure | 17 (53) |
|
Stroke | 1 (3) |
|
Prediabetes | 4 (13) |
|
Type 2 diabetes | 3 (9) |
|
Osteoarthritis | 15 (47) |
|
Rheumatoid or inflammatory arthritis | 3 (9) |
|
Chronic low back pain | 1 (3) |
Body mass index (kg/m2, mean) |
|
31 (21-51) |
|
|
|
|
Systolic | 129 (93-182) |
|
Diastolic | 79 (67-95) |
Heart rate (mean) |
|
70 (50-98) |
|
|
|
|
Low | 2 (6) |
|
Moderate | 21 (66) |
|
High | 8 (25) |
|
|
|
|
Diabetes before the age of 55 | 5 (16) |
|
Heart attack before the age of 55 | 6 (19) |
|
Maternal history of hip fracture | 2 (6) |
|
|
|
|
High school | 6 (19) |
|
Trade school | 2 (6) |
|
College | 7 (22) |
|
University | 7(22) |
|
Graduate school (MSc, PhD) | 7 (22) |
|
Professional degree (MD, MBA) | 1 (3) |
|
|
|
|
<CAD $20,000 | 2 (6) |
|
CAD $20,000-CAD$49,999 | 6 (19) |
|
CAD $50,000-CAD $79,999 | 12 (38) |
|
>CAD $80,000 | 10 (31) |
|
Prefer not to say | 2 (6) |
|
|
|
|
Nonuser | 1 (3) |
|
Novice | 6 (19) |
|
Intermediate | 19 (59) |
|
Expert | 5 (16) |
|
|
|
|
Daily | 28 (88) |
|
Weekly | 2 (6) |
|
Monthly | 0 (0) |
|
Rarely | 0 (0) |
|
Never | 1 (3) |
|
|
|
|
Daily | 22 (69) |
|
Weekly | 0 (0) |
|
Monthly | 0 (0) |
|
Rarely | 0 (0) |
|
Never | 12 (31) |
aPercentages may not add up to 100% due to incomplete surveys or multiple answers.
We included 32 adults over the age of 50 living in southwestern Ontario who had been diagnosed with a chronic disease that could be prevented with physical activity. We excluded individuals who could not speak or read English and who had contraindications to physical activity according to the Physical Activity Readiness Questionnaire [
Focus groups were conducted at the end of each study group. We chose to do a high-level thematic analysis with the purpose of examining and recording the patterns in our data [
The TAM identifies two key beliefs as the primary reason for behaviors that encourage computer and technology acceptance:
Our data were coded and analyzed in NVivo (QSR International) in 3 stages. For the initial stage of analysis, 1 independent researcher (KM) coded data by briefly summarizing each line and then paragraph of data. In the second stage of coding, the codes were combined into themes by 2 researchers (KM and KG). In the third and final stage, each theme was populated by representative quotations (KM and KG).
We recruited a purposive sample of 32 participants aged between 52 and 85 years (mean 64 years;
Because our goal was to explore acceptability, which is based on participant’s perceptions of usability and usefulness, a sample size of 32 was adequate. We also continued sampling until data saturation was reached and no new ideas or issues were identified [
Participant experience questionnaire (answer averages) evaluating the use of wearable activity trackers.a
No | Feedback | Withings | Fitbit Zip | Jawbone | Pedometer | Shine | Average |
1 | Overall, I was satisfied with the activity tracker. | 3.39 | 3.57 | 3.33 | 1.77 | 3.37 | 3.09 |
2 | Using the activity tracker helped me set activity goals. | 2.90 | 3.13 | 2.93 | 2.55 | 3.13 | 2.93 |
3 | Using the activity tracker helped me reach my activity goals more rapidly. | 2.81 | 3.03 | 2.67 | 2.19 | 2.80 | 2.70 |
4 | Using the activity tracker helped me to be more active. | 3.00 | 3.20 | 3.10 | 2.65 | 3.13 | 3.02 |
5 | Using the activity tracker made it easier to be more active. | 2.84 | 3.00 | 2.87 | 2.35 | 2.83 | 2.78 |
6 | Using the activity tracker supported me in managing my disease. | 2.61 | 3.00 | 2.60 | 2.23 | 2.70 | 2.63 |
7 | I found it easy to learn to operate the activity tracker. | 2.84 | 3.27 | 3.13 | 2.84 | 3.00 | 3.02 |
8 | I found the activity tracker to be clear and understandable to use. | 3.06 | 3.40 | 3.07 | 2.90 | 2.90 | 3.07 |
9 | I found the activity tracker to be flexible to work with. | 3.00 | 3.37 | 3.23 | 2.42 | 3.03 | 3.01 |
10 | Overall, the activity tracker was easy to use. | 3.03 | 3.43 | 3.43 | 2.74 | 2.97 | 3.12 |
11 | People who influence my behavior would think I should use the activity tracker. | 2.65 | 2.93 | 2.87 | 2.68 | 2.86 | 2.80 |
12 | People who are important to me would think I should use the activity tracker. | 2.74 | 3.00 | 2.97 | 2.68 | 2.97 | 2.87 |
13 | I have the technology necessary to use the activity tracker | 3.45 | 3.90 | 3.43 | 3.65 | 3.50 | 3.59 |
14 | I have the knowledge necessary to use the activity tracker. | 3.26 | 3.67 | 3.47 | 3.90 | 3.33 | 3.53 |
15 | The activity tracker was compatible with other systems I use. | 2.84 | 3.53 | 3.23 | 2.47 | 3.23 | 3.06 |
16 | I am very knowledgeable about my physical activity needs. | 4.00 | 4.17 | 4.03 | 3.90 | 4.03 | 4.03 |
17 | I understand how to use physical activity to manage my health problems. | 4.06 | 4.17 | 4.03 | 4.13 | 4.07 | 4.09 |
18 | The activity tracker was comfortable to wear. | 3.87 | 4.13 | 3.70 | 3.13 | 4.10 | 3.79 |
19 | The activity tracker accurately tracked my physical activity. | 3.48 | 3.50 | 3.67 | 1.77 | 3.77 | 3.24 |
20 | Average by tracker (SD) | 3.15 (0.43) | 3.44 (0.40) | 3.25 (0.40) | 2.79 (0.67) | 3.25 (0.44) |
|
aScoring was as follows: 1=strongly disagree, 2=disagree, 3=neutral, 4=agree, and 5=strongly agree.
Of the 32 participants, 30 completed the testing of all devices; 2 users dropped out after testing the pedometer (initial stage), citing acute viral illness. All the wearable activity trackers tested had moderate acceptability, with the standard pedometers having the lowest acceptability to users (
In general, all the wearable activity trackers tested had a similar score for each item of the TAM questionnaire and were rated higher than the standard pedometer in all items but 13 and 14, both of which are related to baseline knowledge of the technology. This coincides with the exit interview ratings, where participants constantly rated the standard pedometer as their least preferred option.
The language participants used about wearable activity trackers was also notable. Participants would pick a favorite device, and stick with that device, even if through later discussion they identified more negatives than positives about that device. The common reasons for liking or disliking a device are how they looked, be it for subtle or fashion-based factors, and ease of use. The participants’ perceived comfort level with the devices was another notable aspect of this study that drove how participants ranked the devices. We also found that the wearable trackers performed highest on items assessing ease of use, namely, Item 10 “Overall, the activity trackers were easy to use” and Item 14 “I have the knowledge necessary to use the activity tracker.” The highest rated item was Question 16, “The activity tracker was comfortable to wear.” This was reflected by low scores for Item 7 “I found it easy to learn to operate the activity tracker” for the Withings and pedometer (2.84) compared with the Fitbit (3.27), Jawbone (3.13), and Shine (3.00), which contributed to decisions to purchase or not purchase (
After testing the devices, none of our participants planned to purchase a Mio or Sportline pedometer, whereas 22 of the 30 participants who completed the study said they would purchase a wearable activity tracker. The participants were asked which device or devices they would potentially purchase, and after trying the devices, 30% (N=32) felt they would buy a Jawbone Up 24, 30% would purchase a Misfit Shine, 33% felt they would buy a Withings Pulse, and 40% felt they would buy a Fitbit Zip. At the completion of the study, 73% (22/30) felt they would purchase a tracker and 67% (20/30) felt they would purchase a device for a friend or family member. Those who felt they would not purchase a tracker included reasons of cost, lack of interest, and complexity of the devices.
Mean participant acceptance scores from the participant acceptance questionnaire for each wearable activity tracker assessed.a
App | Mean score (SD) |
Pedometer | 55.7 (10.2) |
Fitbit Zip | 67.6 (15.8) |
Jawbone Up 24 | 65.8 (19.1) |
Misfit Shine | 64.7 (13.7) |
Withings Pulse | 62.9 (13.8) |
aMinimum score was 19 points; maximum score was 95 points (N=30).
Positive statement associated with individual fitness trackers.
App | Positive statement |
Pedometer | “I just want a step counter, I don’t care about the rest of the stuff” |
Fitbit Zip | “The Fitbit I still say is the easiest. I actually got an email that tells you your weekly progress, and I really like that.” |
Jawbone Up 24 | “I liked the sleep data a lot, and I found the Jawbone easy to use. I found it really easy, it was light.” |
Misfit Shine | “I really liked that I could wear it in the water |
Withings Pulse | “A lot of people say they don’t like the Withings, but I really did, I thought it was great” |
Negative statement associated with individual fitness trackers.
App | Negative statement |
Pedometer | “The very first one, the pedometer was unbelievably off. I would take one step, and it would count 10.” |
Fitbit Zip | “It was too small, I was scared I would lose it” |
Jawbone Up 24 | “Jawbone, see look, this is by far the easiest to put on and off but once it's on it can get a little annoying” |
Misfit Shine | “The Shine I thought was just the most unintuitive, poorly constructed system” |
Withings Pulse | “The reason I didn't choose it is because I was afraid that over time it would all break.” |
In this study, 4 overarching themes emerged to describe how acceptable wearable activity trackers are for older adults with chronic disease. The first theme is that new and emerging consumer health technologies are likely to be outside the older user’s perceived comfort zone. However, the second theme is that after a brief trial period, users can appreciate that wearable activity trackers improve self-awareness and goal setting. The third theme was that wearable activity trackers are ultimately more useful as motivators than as quantifiers. The final and fourth theme was that older adults are unlikely to adopt wearable activity trackers if the trackers are not sold and managed as health care devices.
There is a perception that the navigation of devices and apps requires technological know-how that is often absent in the older adult and elderly population. Modifications of the TAM have identified technical know-how as a form of self-efficacy that influences a user’s
I wonder if people looking at getting one would see younger people wearing these, but that might be a deterrent, saying “well, that's only for young people.”
I think the right person is someone who has patience and a real understanding that this person doesn’t get it because they’re simple or stupid or whatever, it’s only because it is like a foreign language to them. So for our generation, they need to back it up and simplify the steps.
TAM additionally identifies the lack of instructions as a barrier to a person adopting, because it is a barrier to
If you look at that little Fitbit, it doesn’t have any instructions with it. That almost did me in. I waited for a child to come along. But I also had to take into account the feelings, like you don’t feel, you feel really limited, you know you feel really badly when you can’t figure it out.
I couldn’t figure out how to get steps, it kept giving me some percentage of my daily activity and I couldn’t figure out how to get the steps. So I was told to go online. Of course that seems so intuitive, but for me it wasn’t. The fact that they don’t come with written instructions I think is a real downside.
A more practical consideration is comfort, identified by the TAM as
I don’t know which I found most comfortable. I might take the Jawbone because it would stay on. As opposed to the Fitbit I’m not sure if the Fitbit, the way it’s designed there would stay on, and I had trouble clipping on some of the other ones—I didn’t trust they wouldn’t fall off.
...[The Jawbone Up 24] was a really beautiful object so you have to kind of get behind that specific look. I like Italian rubber design jewelry so I didn’t mind that this is a nuisance to take off and on cause it’s a cool look. If I’m looking for what I feel comfortable with wearing, I would like a fashion statement.
The wearable activity trackers may be less useful for individuals less familiar with mobile technology. For this group, simpler devices with clear displays should suffice.
None of my friends [aged] 80-90 that I play cards with would, they were interested in what I was wearing, but they weren’t interested in it for themselves, they don’t care how many steps they take, they sit most of the time. We read and play cards. We do a bit of exercise, we walk a bit, but as far as wearing one of the simple devices, maybe, but I found those that are more complicated they don’t have the iPad, no computer, but they couldn’t even use it so, we’re out.
The greatest advantage to wearable activity trackers is that they help participants become more aware of their activity levels. TAM identifies
It was more informative than motivating, because I had my own agenda that my doctor set out for me to do.
I’m just interested in the number of steps and exercise really. As far as living healthy, I think we all know what we’re supposed to eat, what our blood pressure should be at and all these sorts of things.
However, even if participants thought they were active, they either wondered or worried that they were not as active as they should be.
At least it was telling me something, maybe not what I always wanted to know. I didn’t care what it said. I just knew I had it on. So I wanted to try to be more active. I didn’t care what the numbers said but I have to admit that when I did see the numbers I was like, wow, or a couple of days it was like, whoa.
I like the interactive part of these. I don’t really care about the details, and if I’m gaining or losing 500 steps, because I know now I’m not doing enough steps at all, so I had a eureka moment when I thought I need to notch this up and stop being so lazy.
Triggers from the activity tracker such as a vibration to alert the user after a period of inactivity (Jawbone Up 24) also increased awareness more than motivation. TAM suggests awareness as a motivator to adoption, falling closely in line with
It’s not a motivation, it’s an awareness. I had it set to inactivity buzz every 15 minutes and at times I wouldn’t get up but it was enough to motivate me to realize I just hadn’t moved.
Well it reminded me, but it didn’t get me moving. I was working on a computer, and it would buzz, lying down watching a program. I think I had it set for every 20 minutes to vibrate so it lets you know that you’re inactive, but what I did after the reminder to move was up to me.
Participants were less interested in being motivated by the activity tracker than in being motivated by the self-awareness gained from data collected by the tracker. The
I think the issue is always how do you motivate yourself to do things you know are good for you, so that was part of how I was thinking about it, not just for myself. I’ve been in a really heavy workload so I've been sitting a lot so it actually shocked me to know I only do 2000 steps a day, so that was super motivating for me.
I was diagnosed years ago with osteoporosis so I’ve always felt like I need to have at least 3 hours of activity in the bone bank, and once I retired I thought not good enough, I need to have 4 or 5 hours in the bone bank. I found using these helped. That, well, my husband said I was developing obsessive compulsive disorder because I was constantly moving, I’d run up and down the stairs, or I’d dance with a grandchild or something and I’d look down. So it was hugely motivating.
Self-awareness translated into motivation when it made activity a game or competition for some participants. For participants, the “goal” of 10,000 steps seemed to matter less than being aware of how much, or how little activity they got, compared with where they wanted to be.
I was trying to get to 10,000 steps and I did, a few times, it was fun, and you could see most of the different things...you know my activity level is higher at this time and lower at that time, and let’s run up and down stairs a couple times, and I got another 2 minutes. It was a lot of fun.
The goal was 10,000 steps. These trackers really let you know how much more than your daily routine you really need to put in to get to that goal. Doing your normal day-to-day thing, you’re not even close.
As demonstrated by our oldest user, for users who are isolated in their home, the wearable activity trackers may help users compete against themselves more easily by automatically collecting data and tracking it over days and weeks.
Very definitely, you know you compete with yourself. I have no one else to compete with. This winter has been hard, for going outside and walking. I used to be able to walk, or I used to be a swimmer, and now I’ve become a couch person...I’ve done the track in the house, I run up and down the stairs, down to the basement and I walk my driveway a couple of times cause it’s long. I try and I compete with myself and I know that I sit or lie down much too long. But when you’re over 80 I think that’s excusable.
Overall, participants generally enjoyed trying out the wearable activity trackers (
I think the next step should be a handout in consultation with medical groups like pharmacies and in partnership with provincial and federal groups and maybe even activity groups like the YMCA to come up with a really effective comprehensive, simple pamphlet pointing out the importance of what you do in the hours you’re awake. I think then we’ll need some kind of financial incentive because there are limitations to people being able to afford a tablet and the device.
In Canada, physical activity trackers are not taxed if bought with a prescription. Several of our participants also stated they wished the devices were available in pharmacies because they did not go into the electronics stores where the devices are traditionally sold.
But if someone can guide you through it, I think any of them, once you start using them you would probably use it. But I wouldn’t go to Best Buy I wouldn’t have thought to go to best buy. If it’s for my health, I would think to go to a pharmacy.
There was also a noted desire to learn about the devices from someone in health care. The participants were interested if their doctors or other health care professionals would be interested in the data provided from the devices. There was also a noticed interest in pharmacies carrying the devices, and having pharmacists able to explain how to use them, similar to how health-monitoring systems such as blood glucose meters or blood pressure meters are explained by pharmacists. Several times a barrier to learning was that the participant asked older/adult children for help using the device, and was met with impatience and frustration.
My daughter was no help at all. She just kept saying it’s stupid, I don’t have time.
Negative words:
Annoying
Challenging
Stressful
Hard
Frustrating
Neutral words:
Instructive
Learning experience
Interesting
Informative
Fine
Educational
Life
Experiential
Positive words:
Fun
Exciting
Motivational
Comfortable
Motivational
Running from January 2014 to June 2014, our study included 32 older adults living with chronic illness who were trying wearable activity trackers for the first time. We found that the study participants generally enjoyed using the widely available trackers and even preferred them over the standard pedometer. Our participants also found the trackers to be useful in promoting self-awareness and motivation. However, it should be noted that at the time of this study, these trackers were an emerging technology; thus, participants often felt that these devices were too new to be comfortable with. When asked, our participants suggested that wearable activity trackers should be recommended for health care rather than entertainment. To meet this final theme, it was suggested that the devices be available at pharmacies and sold alongside blood pressure and blood glucose meters with the standard health-related tax exemptions or credits.
At the beginning of the study, the initial feedback during recruitment from several older adults and seniors was that they did not use mobile phones and tablets and were unsure whether they were the right choices for the study. Throughout the study, however, we found that these participants were often the ones who had the least trouble adapting to new technology, and many times knew more about new technologies than they thought they did. Frustration often came from the apps during use, and the lack of clear instructions for installation rather than understanding and using the technology.
Research into wearable activity trackers is a new area but it is closely tied to the growing body of research in mHealth. Several previous studies have evaluated the use of mobile phones in supporting health care and public health interventions, particularly in the collection of data for health research [
Traditional pedometers digitally monitor and track basic physical activity. They are essential to programs that recommend a specific daily step count. Many of the participants we interviewed cited comfort and experience with using pedometers because they are appealing to older adults uncomfortable with technology. However, long-term tracking requires manual data entry, which hinders engagement of the user. The wireless transmission of data allows for timestamps, measurement of intensity, frequency and duration ideally without significant input from the user, and then sending the data automatically to devices that report back to the user such as mobile phones, tablets, and computers [
Some of the most important lessons we learned over the course of this study were related to how our participants were using the new technologies in their daily lives. We heard from several participants that adult children were encouraging them to get a mobile phone or had bought or handed down a tablet. In one case, an adult child had recently gifted a participant with a Jawbone Up 24. We found that often our participants were not aware of how much they used the new apps and technologies, citing that they just used their tablet for email and simple card games. As we spent more time with each participant, we saw them browsing for health information, using tablets to check the stock market, checking Facebook, tracking calories, and playing new games.
More research needs to be carried out to fully understand the best practices for designing wearables for older adult populations. There is significant potential for stakeholders to promote and use wearables as a tool to encourage, motivate, and assist older adults in improving their health. Future wearables could benefit from including a simple paper-based instruction manual that clearly addresses set up, how to use the device. and basic problem solving. This would provide knowledge to older adults in a medium they are familiar with, which has potential to increase adoption. There is also significant potential for designing wearable fitness trackers in a way that older adults can benefit from both on the device itself and in the accompanying app. Displays should consider using large, high-contrast text with large light-on-dark letters and numbers to allow for easier viewing. In addition, allowing access to device knowledge on both a computer and a mobile app would allow older adults to access data in a more familiar way, in terms of comfort with technology and by allowing them to view results on a bigger screen. Waterproof design decreases worry about the fragility of the device if it is forgotten, and accidentally damaged by doing dishes or the laundry, and also allows older adults to use it in the water-based activities that are commonly recommended by health care providers as part of a low-impact way to increase physical activity.
The primary limitation of our study is that we gave participants the devices for a purposely short period, with the goal of getting initial impressions. There is significant opportunity to test wearable devices for longer periods to determine long-term adherence as well as to test the devices with a population that is more universally sedentary. We also purposely ran our study in the winter to spring months, when many of our participants self-identified as less active than they would be in the summer. A key driver of this project was to determine if awareness in their actual activity times would increase or decrease dependent on awareness despite there being challenges to simply “going for a walk.” Given the qualitative nature of our inquiry, we were also careful to not focus on the effects of the wearable activity trackers on step counts.
In conclusion, our goal with this study was to determine the acceptability and usability of the various wearable fitness trackers for adults over the age of 50 and whether the devices may be something these adults would be interested in, acknowledging that we are in an early adopter phase with this technology. We worked with 30 adults (all aged >50) with a chronic illness to determine how they perceive the usability and acceptance of wearable fitness trackers. Overall, we found that there was a meaningful potential in using wearable fitness trackers as a multifaceted intervention to help older adults become more active. If health professionals can help older adults become more aware of wearable activity trackers, there is potential for adoption, and through adoption, for creating more awareness of physical activity levels. The benefits of mHealth technologies, specifically in this case wearable activity trackers, lie in their potential to overcome barriers between patients, clinicians. and researchers through giving users independent insight into the realities of their physical fitness, which translates into their awareness of their active times and arguably most significantly, awareness of user’s own real levels of physical activity.
metabolic equivalent of task
Technology Acceptance Model
None declared.