In an more and more related earth, cell products have come to be ubiquitous1. Wearable devices, which include fitness trackers (referred to all over the paper as “wearables” and “fitness trackers” interchangeably), offer almost constant info on bodily action, coronary heart price, and rest. As use boosts, information are more and more integrated into scientific and investigate options. There is emerging proof that health and fitness trackers can recognize adjustments in heart fee variability, likely pinpointing COVID-19 onset prior to a scientific prognosis2. Nevertheless, there is a deficiency of range in reports applying wearables to examine health and fitness outcomes3. Irrespective of an boost in broadband and smartphone possession and use across the United States, obtain to electronic wellbeing technologies in decrease-money households lags behind center and upper-income homes4. Enhanced access to electronic infrastructure and gadgets in numerous communities is required to prevent the risk of digital systems becoming yet another social determinant of well being5.
A person of the main values of the Nationwide Institutes of Health’s (NIH’s) All of Us Analysis Software is diversity in all factors of the method, including participants, consortium associates, software staff, and scientists6. Variety of the underlying knowledge from participants is crucial for reducing bias in precision drugs study, which aims to uncover best clinical methods at the individual, not inhabitants, level. The program welcomes contributors from all backgrounds and aims to replicate the rich range of the United States by enrolling individuals from communities that are historically underrepresented in biomedical exploration (UBR), these types of as racial and ethnic minority groups and those people with limited obtain to health-related treatment7. Recognizing the price of electronic health and fitness technologies for study and wellbeing, the system launched Fitbit Carry-Your-Personal-Gadget (BYOD), enabling members to donate their Fitbit data to the system8. Having said that, when All of Us Fitbit participant demographics were in contrast to all method participants, a reduction in diversity in race and socioeconomic status was mentioned9. This examine was intended to arrive at various communities served by Federally Qualified Wellbeing Centers (FQHCs) to realize the gaps to participation in Fitbit BYOD.
To bridge this information hole, six FQHCs that are also a part of the All of Us Consortium executed a survey to acquire patients’ demographic information and facts, desire in obtaining a health and fitness tracker, and other variables most likely associated with this interest. Descriptive studies, univariate and multivariate logistic regression, and qualitative assessment of no cost-textual content responses had been utilised to analyze the results (see “Methods” for specifics see Supplementary Fig. 1 for a map of collaborating FQHC internet sites).
Of the 1007 grown ups surveyed, 39% identified as Hispanic, 36% as non-Hispanic Black or African American, and 15% as non-Hispanic White (Fig. 1). Just about 3-quarters determined as cis-gender ladies (71%), 14% had much less than a 9th-quality schooling although 45% experienced completed higher college, and members had been evenly divided across age teams. The surveys were administered in English (68%) and Spanish (32%). The main result was no matter whether contributors would like a physical fitness tracker, and overall 58% responded “yes,” 20% “no,” and 23% did not reply (Fig. 1).
Individuals were requested a selection of thoughts about their publicity to, possession of, fascination in, and familiarity with health and fitness trackers. Determine 2 displays participants’ possession fee and curiosity in physical fitness trackers. Contributors were questioned about barriers to possessing a fitness tracker. These “Hindering factors” involve price, a standard consciousness of health trackers, and particular details about how they can deliver health and fitness insights, language, and support about the cell phone vs thoroughly electronic strategies. Respondents had been also questioned about valuable factors for working with health trackers, mixed below “Helping factors” as recommendations for potential strategies to mitigate disparities in digital health and fitness engineering use. These incorporate an desire in owning a product and discovering about how physical fitness trackers can be used to keep track of health, a willingness to share data for exploration, owning a smartphone and knowledge of how to download and use apps, and an curiosity in finding out much more.
A number of aspects have been connected with “would you like a physical fitness tracker” at the .05 importance amount using two-sided exams (Desk 1). Members who responded they would like a health and fitness tracker experienced increased odds in univariate logistic regression styles of figuring out as a cis woman (odds ratio (OR) = 2.13, 95% CI:1.50–3.04, P < 0.001), being a participant from the Cooperative Health FQHC (OR = 3.13, 95% CI:1.69–5.86, P < 0.001), having a smartphone (OR = 2.02, 95% CI:1.36–2.97, P < 0.001) and knowing what a fitness tracker is before taking the survey (OR = 1.79, 95% CI:1.29–2.49, P < 0.001). In the multivariate logistic regression model, participants who would like a fitness tracker were more likely to be among the 46–55 and 56–65 age groups and identified as non-Hispanic Black or African American. Participants who had a smartphone at the time of the survey and knew what a fitness tracker was before the survey were also more likely to want a fitness tracker. Not having a fitness tracker because they “are too expensive” and “do not understand how it can help participants, but want to learn” were also associated with answering yes to, “would you like to use a fitness tracker?” Not having a fitness tracker because “they are not helpful” or “do not want to commit to using it every day” were associated with answering “no.” These factors, including education and training on the value of these devices, could be considered when designing research studies and programs to improve digital health equity.
Results from a qualitative content analysis were consistent with the quantitative findings. The top three themes were “no interest,” “lack of knowledge,” and “lost/broken device.” Over half of the qualitative responses to “why do not you have a fitness tracker” were coded as “No Interest” (52%, e.g.,: “I’ve never thought of having one,” “never considered it”). This may also be a result of limited awareness or knowledge of potential health impacts. Other common responses fell under the theme of lack of knowledge (18%, e.g.,: “didn’t know what they were”). While cost was not identified as a main theme among the open-ended questions, “lost/broken device” was prevalent, suggesting that cost may be a barrier to replacing a previously owned device. Our findings suggest that widespread adoption and use of digital health devices are possible across diverse communities, but would require a high-touch approach, including educational materials and public or private financial investment in devices. Limitations of the study include the surveyed patient sample may not be fully representative of the patient population of the six FQHCs, and the lack of a second parallel reviewer in the qualitative analysis.
The majority of patients surveyed are interested in using digital health devices and learning how these devices could improve health. However, cost and understanding how they work are important barriers that could prevent individuals from realizing the benefits of wearable digital health devices such as fitness trackers (Fig. 2). Consideration of cultural nuances are also important, for example with the terminology used to name these devices. In the course of this study, we learned that many Spanish-speaking participants were concerned that these devices could be used to track their movements, because of the word “trackers.” With the increase in telehealth and telemedicine use due to the COVID pandemic, access to digital health technologies is increasingly important. However, as the use of digital technology expands into health care, careful consideration is required to ensure that existing health equity gaps are not exacerbated and additional health equity gaps are not created.
While studies have been conducted on the use of wearables, very few have specifically sought input from UBR populations. In this study, patients were given the option to complete the survey in English or Spanish one-third completed in Spanish. A Pew Research study10 found 21% of Americans use smartwatches or wearable fitness trackers. Use was greater for those with a higher annual household income and those identifying as white and/or non-Hispanic. More than 65% of the Pew survey participants identified as white and had an annual household income greater than $30 K per year. In contrast, over 70% of participants in our survey do not identify as white (36% identify as Black or African American compared to 10% in the Pew study, and 39% identify as Hispanic compared to 14% in the Pew study). Based on health center data, 90% of the patients at our recruitment centers have an annual income at or below 200% of the Federal Poverty Guideline. Data collected from FQHC All of Us participants indicate that 38.3% have an annual income of less than $10 K, 23.9% have incomes between $10 and $25 K, and 7.9% between $25 and $35 K, with 21.7% preferring not to answer. Our results align with recent findings by Tappen et al11, where significant differences in computer ownership, internet access, and use of digital health information were observed among older racial and ethnic minority individuals when compared to white adults of similar ages. Older age, lower education, lower-income, and minority racial and ethnicity identification predicted limited digital health information use11.
Wearables are evolving to monitor more specific health concerns, including diabetes and heart disease, two conditions that are prevalent in African American and Hispanic communities. Inclusive use of digital health technologies in research and clinical practice will likely require strategic planning for devices, infrastructure, and education about digital health technologies. Most individuals surveyed have smartphones and know how to install apps, but would benefit from additional information on how fitness trackers can be used to improve health. Since the cost of a device was one of the most hindering factors noted in the survey, investment is needed to help overcome this barrier to entry. There is a risk of increasing health disparities through noninclusion in research and clinical care using wearables and other digital health devices the diverse participants in this study indicated interest in fitness trackers, but barriers such as cost and education exist. Future research to understand potential health disparities and inequity could investigate other evidence-based digital health solutions and real-world data beyond fitness trackers. The All of Us program is committed to engaging with diverse communities and building relationships with community leaders in order to gain trust, but is only one research program. The results of this survey suggest that additional investment in devices and educational materials from other clinical and research programs could contribute toward reducing disparities.