As the world continues to become increasingly connected, mobile devices have become ubiquitous. Wearable devices, including fitness trackers provide nearly continuous information on physical activity, heart rate, and sleep. As the use of these monitoring increases, data are increasingly integrated into clinical and research settings. There is emerging evidence that fitness trackers can identify changes in heart rate variability, and other symptoms including the potential to identify COVID-19 prior to a clinical diagnosis.
Unfortunately, an understanding of how digital health technologies can be used for equitable healthcare across diverse communities is needed.
It seems that most people who use smartwatches and other wearable devices that can track health are white, well-educated, and wealthy.
Recent research published in Nature’s NPJ Digital Medicine Journal, intentionally included groups that are historically underrepresented in medical research e.g. lower-income groups and racial minority groups. The goal was to find out the reasons for lack of interest or reduced adoption of fitness trackers.
The study was conducted by researchers at the All of Us Research Program, an initiative at the National Institutes of Health aiming to build a health database that’s representative of the United States. As part of the program, the researchers wanted to let program participants send health data directly from Fitbit devices. They found, though, that the demographics of the people who decided to send data were whiter and wealthier than the racial and socioeconomic diversity of the project as a whole.
To figure out why, the team surveyed over 1,000 patients at six Federally Qualified Health Centers, which provide medical care to underserved communities. Around 40 percent of the people who responded identified as Hispanic, 36 percent as non-Hispanic Black or African American, and 15 percent as non-Hispanic white. Two-thirds of the surveys were done in English, and one-third were done in Spanish. Most had a high school education or less.
Over half of the people who responded to the survey said that they’d be interested in a fitness tracker, saying that they’d be interested in things like tracking their steps or heart rate.
Of the group that was interested, 49 percent said that they don’t have a tracker because they’re too expensive. Almost 20 percent said that they don’t know how to use them, and 15 percent said that they don’t know how a tracker could help — but want to learn.
The research team also found that language barriers can dissuade people from using a smartwatch: many Spanish-speaking participants were concerned by the use of “tracker” to describe the devices and thought that their movements would be monitored.
As more and more health features get built into wearable devices, they’re becoming a major tool used both for individual people’s health and for medical research. But if groups like the ones served by Federally Qualified Health Centers are shut out from the products, smartwatches just end up reinforcing existing equity gaps in healthcare and in health research. When groups aren’t represented in studies, results can’t be generalized to those groups, and they miss out on the benefits of new findings.
Source: Hook M, Litwin TR, Munoz F, et al. Wearable fitness tracker use in federally qualified health center patients: strategies to improve the health of all of us using digital health devices. npj Digital Medicine Vol 5, Article number:53 (2022).