Exploring digital health: a qualitative study on adults’ experiences with health apps and wearables

ABSTRACT

Purpose

From an active ageing perspective, investigating how adults use apps and wearables for health purposes might improve well-being strategies supported by widely adopted technologies. This study investigated adults’ perceptions of using apps and wearables for health purposes.

Methods

A qualitative interview study was conducted. Adults (+18) using an app/wearable to monitor at least one health variable (e.g. physical activity and diet) were eligible. Transcriptions were analysed using the Reflexive Thematic Analysis.

Results

Nineteen participants (34.3 ± 14.5 years; men/women: 8/11) joined the study and from their transcriptions 5 themes were created: 1) Easy and accurate monitoring of health: balancing users’ needs and technological challenges; 2) Self-improvement and motivation: usefulness of rewarding behaviours and gamification towards achievements; 3) Requiring personalized apps and wearables: aesthetics and wearability; 4) Beyond simple monitoring: prevention and care throughout daily life; 5) Awareness of potentially dangerous digital data world: from distress to fixation.

Conclusions

Apps and wearables were highly valued by our participants for effectively managing and enhancing their health and sports performance while ensuring education, motivation, ease of use, safety, and prevention. However, issues such as privacy concerns, wearability, and lack of integration need to be addressed to improve adoption, enhance usability and support active ageing initiatives.

Introduction

Health is defined as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (Schramme, 2023). This broad and multifaceted definition allows for addressing either individual health domains (e.g., physical activity and diet) or multiple ones simultaneously to impact overall health and well-being. While the latter approach is often more effective in addressing comprehensive health and often adopted in active ageing strategies for lifestyle changes, it is also more challenging due to the need for continuous monitoring of different health variables, as well as providing personalized advice. These tasks are crucial in active ageing strategies addressing different health domains and can be helped by adopting the right technology, which can efficiently collect and analyse vast amounts of real-time data from multiple sources (Kumar et al., 2023; Park, 2016) and provide personalized instructions based on individual’s needs and characteristics to improve their lifestyle habits. Among the various technological solutions available, apps and wearables might be particularly advantageous in this population. As already reported in literature, they are widely adopted (Marcolino et al., 2018) and appreciated (Szinay et al., 2021) and are also capable of autonomously monitoring different health variables, providing sustainable and comprehensive monitoring solutions (Klonoff et al., 2019). These tools require minimal user interaction and can offer analysed data based on individual characteristics, making them user-friendly and efficient (Deniz-Garcia et al., 2023). Moreover, apps and wearables can generate valuable insights that help users understand their health patterns, self-management and decision-making (Watson et al., 2019) about their well-being. Apps and wearables might be beneficial for adults who face the dual challenge of preventing and managing chronic diseases (Jiménez-Muñoz et al., 2022), supporting the maintenance of overall health over time. Additionally, in an active ageing perspective that fosters health promotion and well-being across different life stages, these tools motivate us to reach a healthier lifestyle, which is crucial for complex and long-term health interventions (Blacket et al., 2024; Woldaregay et al., 2018). In line with this and considering that a recent review underlined that apps and wearables seem accepted by adults (Baer et al., 2022), these technologies might support them in both monitoring and improving their health variables, as well as teaching them the importance of doing so. By offering personalized feedback and tracking progress, these technological tools support and empower users to take proactive steps towards improving their overall health status (Okolo et al., 2024).

However, despite these benefits, apps and wearables have some limitations that have already been explored in previous studies (Peng et al., 2016). Due to continuous data monitoring, they could prompt the need of checking data and achieving certain goals, as well as creating the need of inserting data to monitor them (König et al., 2021). Privacy concerns are also a significant barrier for many, especially when dealing with medical or health variables (Schroeder et al., 2022). Additionally, while these devices are designed to be user-friendly, older adults or those unfamiliar with technology may experience usability challenges, limiting their adoption and effectiveness (Vasiloglou et al., 2021). Another drawback is feeling discouraged when they cannot meet device-generated goals, a lack of personalization or receiving too many notifications. Furthermore, costs related to these technologies can make them less accessible to individuals from lower socioeconomic backgrounds, exacerbating health inequities (Giebel et al., 2023).

Hence, considering both their advantages and disadvantages already reported in literature, it might be important to expand the knowledge around this topic to try to better understand adults’ opinion on these technologies. Thus, undertaking a comprehensive investigation of the positive and negative expectations and experiences (Pyo et al., 2023) of adults using apps and wearables for health purposes addressing their lifestyle habits, this research aims to explore insights that can help adults and health professionals better understand the use of these technologies in adulthood, unveiling barriers and preferences in using them.

Methods

Study design

A qualitative study was conducted to investigate adults’ experience of using apps and wearables for monitoring and enhancing health variables. Semi-structured individual interviews were used to give participants the freedom to be able to share as much information as possible without worrying about time constraints on other participants, as could happen in focus group sessions. The ethical approval was obtained from the Medical Ethics Committee of the UZ Brussel (BUN: 1432023000314; EC-2023-372, approval date 28/02/2024) and the study was performed at the Vrije Universiteit Brussel (VUB). The conduction of this study respected the Declaration of Helsinki, the ICH-GCP guidelines and the reporting of this manuscript followed the Consolidated Criteria for Reporting Qualitative Research for reporting qualitative studies (COREQ) (Tong et al., 2007).

Participants and setting

The inclusion criteria required participants to be adults aged 18 years or older who were using an app or wearable device to monitor at least one health variable (e.g., physical activity, sleep, or calorie intake) at the moment of the research, and who could read and speak English to participate in an online interview. Exclusion criteria included an inability to read and speak English for providing informed consent and participating in the interview, as well as failure to provide informed consent, not using an app/wearable for monitoring health variables at the time of the research. No upper age limit was set to ensure the inclusion of a broad age range of participants aged 18 and older. Purposeful sampling (Moser & Korstjens, 2018) was adopted to gather high-quality information about the topic investigated while maintaining a wide range of heterogeneity among backgrounds, ages and characteristics of the use of these devices. Potential participants were invited to participate in the study in different ways: via the researchers, printed and digital advertising also targeting non-educational organization, and invitation during in-person classes at the University Campus. The Campus mainly hosted health sciences courses (e.g., physiotherapy, medicine and pharmacy). The informative note of the study and the informed consent form were provided to participants before participation in the interview. Interviews were hosted online using Microsoft Teams (Suite Office 365; hereafter referred to as “Teams”). Participants were free to withdraw their consent at any time without giving any explanation.

Data collection

A multidisciplinary team of a female sports scientist (GL), a male physiotherapist (BG), a male bioengineer and a female psychologist created a semi-structured interview guide. The semi-structured interview guide is a list of questions that the interviewers use while conducting the interview to be sure that each main point is addressed (Surawy-Stepney et al., 2023). To create the guide, already existing questionnaires were consulted, but not questions were retrieved from them as they were deemed not appropriate for our research question. Therefore, the team created the questions specifically for this study. In order to try to obtain higher-quality results, a public representative was involved in the study, following the study-focused framework (Greenhalgh et al., 2019). Our public representative (a female PhD student of 26 years, using a health app) was asked to provide feedback about the semi-structured interview guide, but no corrections were needed (Table 1). At the beginning of the online interview, each participant was asked for a brief introduction to collect data such as age, gender, level of education, job and what type of app and/or wearable they used and for what. Interviews were conducted by one researcher (GL) from March to May 2024 and lasted from approximately 12–32 minutes. At the interviews, only the participant and the interviewer were present. Specifically, a private channel for each interview was created and only the participant, the interviewer and the other authors had access to it. Participants were invited to join with their email after signing the informed consent form and providing an email address. Prior to this, the informed consent form could be signed digitally or manually and then provided to the researchers physically or digitally. At the beginning of each interview, the interviewer reminded again about the necessity of recording the meeting and starting the automatic transcription. After obtaining a positive response from the participant, the recording and the transcription were started, so initially, the data were not collected anonymously. After each meeting the recording was downloaded and used to check and correct the transcriptions and participants were asked if they wanted to check them, but no participant was interested in doing so. In the transcription, each participant was assigned an anonymous ID (e.g., ID1) and then the original recording and transcription were eliminated, as well as the group/private channel. From that moment onwards it was impossible to link any of the personal data such as participant’s name or surname with the data they provided. Anonymised transcriptions were later stored in an online university private server that only the authors can access with a password. Hence, the transcriptions were shared with the other authors to allow the data analysis. These procedures are compliant and approved by the University Committee for Ethical Research that provided the ethical approval for conducting the study with human participants. The interviewer (GL–female) was trained in qualitative research and in conducting focus groups and interviews and tried to maintain neutrality in every interview. Data collection was interrupted when no new patterns of meaning emerged for the interviews and thus data saturation was considered reached.

Table 1.

Semi-structured guide.

N°	Questions	Level	Dimension
1	Describe which apps or wearables you use to monitor physical activity, diet or mental health and if they help you in achieving your objectives.	General question	Motivation of use
1.2	How does the app/wearable fit into your daily routine?	General question	Use
2	Describe what are the strengths and weaknesses in the use of these apps/wearables.	Specific question	Strength and weakness
3	What are the barriers and facilitators in the use of these apps/wearables?	General question	Barriers and facilitators
4	Starting from the app or wearable you already use, describe your ideal app/wearable for monitoring physical activity, diet and/or mental health.	Specific question	Improvements
5	In your opinion, can these apps/wearables be useful to monitor other health parameters? How?	General question	Improvements
6	What suggestions would you give to a friend that does not use these apps/wearables to convince him/her to start using them?	General question	Suggestions
7	Do you want to add any other fundamental aspect that has not been touched yet?	Closing questions	Conclusions

Data analysis

Descriptive statistics was used for the sociodemographic data collected concerning age and gender, while the transcriptions were analysed using Reflexive Thematic Analysis (RTA) (Braun & Clarke, 2023) method as it was deemed the best approach for this research question. In fact, RTA allows for both latent and semantic interpretation of the data collected, and considers experience and language used to describe it to have a bidirectional relationship. Moreover, it can be provided both a rich interpretation of the dataset or a deep interpretation of a specific aspect of it. Additionally, in this method, the researchers’ subjectivity is not a bias but rather a positive element in generating more pertinent results based on the research question. Data analysis codification adopted an inductive approach aiming to catch the richness and variability of data without imposing any interpretative framework (no coding structure was involved). Finally, RTA belongs to the “Big Q” paradigm and therefore it does not adhere to the post-positivism approach that involves minimizing biases such as data saturation, member checking, trustworthiness and coding accuracy (Braun & Clarke, 2023). In line with this, the sample size was calculated according to the “information power” model, which chooses the number of participants based on the study aims, the sample specificity, quality of the dialogue emerged from the interviews and the analysis method (Malterud et al., 2016). Considering the study’s general aim, the sample of interest, the theoretical perspectives of the study, the expertise of the researcher conducting the interviews, and the purposive sample selection, a sample of 12 to 16 participants was estimated. Particular attention was posed to diversify the sample’s characteristics (e.g., gender, age, app or wearable used). The RTA followed the six steps proposed by Braun and Clarke (Supplementary File 1). Initially, two researchers (GL and FR) independently read the transcriptions several times to get acquainted with the data and from them initial codes were created. Afterwards, the researchers compared the codes and later started blindly to group them to create initial themes, based on broader patterns of meaning. Finally, themes were revised, and the final ones were obtained. In case of disagreement in any of these procedures, a third researcher (BG) was consulted to discuss with him, and a consensus was considered reached when at least two researchers out of three agreed. No disagreements emerged during the data analysis. The two researchers independently selected few quotations for each code and then discussed together to obtain two final quotations that better described each code.

Results

A total of 19 participants from Belgium (mean age ± SD: 34,3 ± 14,5 years; females: 11 (58%), males: 8 (42%)) were interviewed, and their transcriptions were included in the analysis. Participants’ characteristics are detailed in Table 2.

Table 2.

Participants’ characteristics.

Participant	Gender	Age	Level of education	Employment	Field of interest app/wearable
ID1	M	20	High school diploma	BSc student Physiotherapy	PA
ID2	F	21	High school diploma	BSc student Physiotherapy	PA + MH
ID3	F	23	High school diploma	BSc student Biomedical Engineering	PA + MH
ID4	F	45	Master’s degree	Tax manager	PA + Diet + MH
ID5	F	49	Master’s degree	EU Employee	PA + MH
ID6	F	47	Master’s degree	Nutritionist	PA + Diet
ID7	F	32	Master’s degree	PhD student Physiotherapy	PA
ID8	F	24	Master’s degree	Part-time worker	PA
ID9	M	36	Master’s degree	Cybersecurity specialist	PA + MH
ID10	F	54	Master’s degree	EU employee	PA
ID11	M	32	Bachelor’s degree	Product Manager	PA + MH
ID12	F	30	Master’s degree	Supplier quality specialist in a pharmaceutical company	PA + MH
ID13	M	76	Master’s degree	Tech company manager	PA + MH
ID14	M	35	Master’s degree	Physiotherapist and university teacher	PA
ID15	M	32	Master’s degree	Secretary	PA + MH
ID16	M	19	High school diploma	BSc student Physiotherapy	PA + Diet
ID17	M	30	Master’s degree	EU employee	PA
ID18	F	19	High school diploma	BSc student Physiotherapy	PA + Diet + MH
ID19	F	28	Master’s degree	PhD student Psychology	PA + MH

Legend: M, Male; F, Female; EU, European Institution; BSc, Bachelor of Science; PA, physical activity; MH, mental health.

From the data analysis, five themes were generated. Two researchers (GL and FR) created initial themes based on data similarity and meaning, emphasizing the wider role that apps and wearables had towards participants’ health. A third researcher (BG) revised the themes with the other two researchers to obtain the final themes. Each theme grouped features or characteristics that reflected a deeper meaning or role associated with the use of apps and wearables for health. A subsequent narration was created using themes, starting from basic elements of health monitoring and its tools to move towards more elaborated concepts and potential risks of health apps and wearables. Final themes created were: 1) Easy and accurate monitoring of health: balancing users’ needs and technological challenges; 2) Self-improvement and motivation: usefulness of rewarding behaviours and gamification towards achievements; 3) Requiring personalized apps and wearables: aesthetics and wearability; 4) Beyond simple monitoring: prevention and care throughout daily life; 5) Awareness of potentially dangerous digital data world: from distress to fixation. Codes and quotations corresponding to each theme are reported in Table S3, Table S4, Table S5, Table S6 and Table S7 in the Supplementary File 3.

Theme 1: “Easy and accurate monitoring of health: balancing users’ needs and technological challenges”

This first theme was generated by the participants’ positive feedback about elements that ease the use of apps and wearables and how these tools could be improved.

Participants viewed the ability to monitor health variables with a single device as a major advantage over using multiple devices simultaneously. Additionally, the possibility to continuously monitor variables with a single device and adopting a multidimensional approach to health (e.g., physical activity and diet) was a key element as participants highlighted that health should be seen through a holistic approach. Health multidimensionality also comprehended medical and non-medical aspects, emergency aspects (e.g., crash accidents and fall detection), prevention ones (e.g., advice for potential allergies and alerts for abnormal values), and leisure-time activities. Using a single app to consolidate all collected data was important for participants, as it increased their awareness of the need for consistent healthy habits over time.

I think it’s important because it really gives you an overview of the level of activity you have, the level of your health in terms of general parameters such as for example heartbeat, you can measure the level of exercise you do every day, how much you sleep, this is also really important because we have to sleep enough hours in order to be healthy—ID5.

Participants emphasized the importance of accuracy in how apps and wearables collect, analyse, and present data automatically. They found it valuable to have objective measurements for health aspects that are hard to quantify, enabling them to track their progress. This accuracy also benefited professionals working with individuals who might struggle to provide reliable health information, such as those with cognitive impairments. Furthermore, objective data helped users verify their assumptions about daily behaviours, like reaching the daily minimum activity level. Automation was considered a key feature, as it reduced the need for user interaction, encouraging adoption and ensuring continuous data collection throughout the day and night and being immediately available when needed. Furthermore, the ability to connect different devices (e.g., apps, wearables, medical devices, and devices from different brands) was considered essential for streamlined monitoring.

It’s so easy that there is almost no reason why I should have a normal watch instead of a smartwatch—ID13.

However, some issues of using health apps and wearables were reported as to be hopefully improved. Poor battery life was a major concern, often necessitating the disabling of continuous monitoring or limiting usage to specific times. Moreover, the lack of integration was viewed as a significant drawback, forcing users to rely on multiple devices, which increased costs and effort in health tracking and data integration, ultimately reducing tool usage frequency. Interestingly, some participants noted that for individuals with chronic conditions (e.g., diabetes), using separate apps could be beneficial, as it helped ensure that important alerts, such as low glucose levels, were not missed. Manual inputs were viewed as burdensome, especially during water activities (e.g., swimming), as they were often misleading, time-consuming, and imprecise. Some participants noted a downside to automation, feeling that not all activities should be counted as “physical activity” (e.g., walking to the grocery store), leading them to disable automatic activity detection. Nonetheless, most appreciated this feature for its convenience, requiring only that they wear the device for the data collection.

Theme 2: “Self-improvement and motivation: usefulness of rewarding behaviours and gamification towards achievements”

This theme was generated by participants’ experience with the reasons and motivational aspects of using apps and wearables for health.

Curiosity was a key motivator for starting to use apps and wearables, helping participants learn more about their health and training performance. Many participants got wearables to specifically monitor health variables (e.g., heart rate and sleep), which sparked interest in other variables and their meanings. Beyond the initial curiosity, the way of presenting data was greatly appreciated as it motivated participants to use these devices. Some, especially amateur runners, got wearables to improve athletic performance but later became interested in injury prevention. Additionally, people expressed a desire for dynamic training plans that could adapt to their individual needs and performance.

It really motivates you to move, to have like your hours of sleep, to push you to drink or whatever—ID17.

Educational features were valued for clearly explaining the importance of a healthy lifestyle, also offering the possibility to read scientific evidence for those interested. Participants appreciated hints for improving their health with sustainable, personalized goals. Moreover, gamification features were seen as essential for boosting motivation and enhancing health outcomes, making the experience of using apps and wearables more enjoyable. However, one participant noted that gamification was less important for him since he was already motivated to use the device. Overall, the discussed features were deemed crucial for engaging users and promoting long-term health improvement through apps and wearables.

The wearable, you can wear it every day and it also gives you like a summary from your day, so like heart rate, activity and that also gives you tips on how to become more active or some small changes you can do to improve your physical activity, or maybe when it sees you’re stressed throughout the day it can give you some exercises to calm down a bit—ID1.

Nonetheless, some elements that required improvement were reported. Specifically, lack of education or information to understand variables and their results hindered the usage of this technology, especially for people less keen on it. Moreover, data and information presented without proper explanation, context and personalization also did not help people avoid thinking they had medical conditions that required further investigations. Additionally, some participants struggled with guidance on using apps and wearables effectively, expressing uncertainty about whether they had fully explored the tools’ capabilities. They suggested incorporating brief videos or explanations as user guides. Finally, some participants noted that the language used was not always easily understood, recommending simpler language, multiple translations, and concise sentences.

Theme 3: “Requiring personalised apps and wearables: aesthetics and wearability”

This theme was created by grouping different aspects of personalization, such as the appearance of apps and wearables (both physical and virtual), and the personalization of features and functions.

Many participants highlighted the importance of aesthetics and appealing characteristics of apps and wearables to better adapt the technology and its characteristics to their needs and expectations. Customizing the interface, watch strap, dashboard, monitored variables, graphics, and notifications was key for maintaining engagement and motivation across various situations, whether formal, informal, or sports related. Additionally, the non-medical appearance of smartwatches made older users more comfortable, as it didn’t highlight health conditions. Some noted that older adults might be more inclined to use wearables if they saw peers or relatives using them. Regarding community functions, just a couple of participants mentioned them but expressed concerns about comparing their results to others.

Participants stayed engaged with their health parameters through personalized goals and the rewards of badges, achievements, and prizes. This aspect was crucial for maintaining consistency, increasing engagement with the device, and driving improvement. Receiving congratulatory notifications upon reaching a goal made participants feel happy, motivated, and amused. Similarly, personalized reminders to complete a goal when close to finishing were seen as highly motivational.

Participants highlighted the need for simpler graphic interfaces and easier navigation in some apps, as confusion often hindered usability and effectiveness. They expressed a desire for fully customizable interfaces, allowing adjustments to colours, fonts, sizes, and displayed information based on their activities. For instance, runners would prefer an intuitive interface that uses simple colour cues, like green or red, to indicate the correctness of their running speed, avoiding the need to interpret numbers.

I think that the app, the features of any app or any wearable should fit one’s life—ID4.

However, participants noted that wearables were uncomfortable during some sports (e.g., climbing and martial arts) or during the night, leading them to avoid wearing them. Common reasons included discomfort (e.g., motion-activated light, skin marks, and the device pressing against certain body parts), fear of breaking the device, and concerns of losing or getting robbed of expensive wearables. Few participants even reported buying cheaper and simpler ones due to these reasons. Women, especially those with small wrists, found wearables too loose, bulky, or lacking in feminine appeal. The size also affected readability, with some displays too small for easy interaction. Additionally, wearables were not always suitable for every occasion (e.g., formal events) or jobs if they were too big (e.g., physiotherapist during clinical practice) or sporty, making both design and functionality issues at times.

Other ones (wearables) are bigger and more sporty that you’re not gonna wear it daily to go to work, or to go to a family gathering or something like that—ID12.

Theme 4: “Beyond simple monitoring: prevention and care throughout daily life”

This theme was created from additional functions that adults considered important in apps and wearables for health purposes.

Notifications and alerts for medical situations were deemed essential for preventing emergencies or severe damage to participants or their relatives. Additionally, these features might also be appreciated by professionals that have to remote monitoring their patients. Participants were willing to manually enter their data if it helped keep them safe and healthy, recognizing the role of these technologies in different prevention strategies. To do so, having and personalizing notifications and alerts for different health variables values or conditions spread a sense of safety in the participants, especially when the device was used by an older adult or by people living alone.

I think especially for some of my patients which have heart fibrillations there’s some new technology going on in which they can get an alert if it’s for example irregular. So, I think that will be very nice, not for me especially, but like in general. — ID18.

Safety features that automatically called for help or call emergency numbers were considered essential, as they could save lives. Car or bike crashes, fall detection, heartbeat irregularities, sharing the GPS position in case of emergency, alerts for pollens present at a certain location, and potential undiagnosed allergies were examples of these features greatly appreciated by participants.

My father already has a certain age and sometimes he goes away with his bike and when he has a crash, there is like a crash-thing feature in his watch that says at which location he crashed—ID11.

Setting alerts for various situations was seen as crucial for preventing injuries and promoting healthier habits and awareness. In this regard, many participants appreciated when the device notified them of being in a too-noisy environment that could hinder their hearing or being in a situation of potential overtraining. These tools also offered solutions, such as suggesting lower exercise intensity, recovery routine or just some advice to limit the exposition to harmful conditions.

If you have, for example, a high heartbeat for some time it can also tell you and this prevents you from some damages, or alerts you in fact, so it’s something positive I would say—ID5.

Apps and wearables also played a preventive role by reminding participants to schedule check-ups, and screenings, or take medications regularly. Participants supported health professionals having access to their data to monitor and detect issues remotely, reducing the need for in-person visits. Access to medical history would also allow professionals to adjust app settings for better personalization. These features were seen as an “extra help” that required minimal effort from users but could have a major impact on daily life. These features might be useful both on individual and community levels, allowing for constantly screening the population and advise them considering local or large-scale conditions. On the other hand, individual data could be compared to those of its corresponding population or community and specific and personalized actions could be suggested.

Theme 5: “Awareness of potentially dangerous digital data world: from distress to fixation”

This last theme was created by reflecting on the negative aspects of using apps and wearables for health and underlining how they could also have risky outputs.

Many participants reported that monitoring health variables could generate distress and obsession both derived from keeping track of a certain variable and especially from manually inserting data. The distress created by manually inserting data into the app was one of the principal drawbacks of using apps, as it may also lead to a fixation.

I don’t think it’s something you should track too much on the other side because I think you can go a little crazy on it too—ID2.

Additionally, seeing abnormal or incorrect data could trigger concerns about potential health issues requiring medical attention. Inaccurate data was a major problem, leading people to lose interest and trust in the device, as well as being potentially dangerous when people completely rely just on what the device tells them. This might be a problem especially for people that do not have expertise in the health field and thus might not recognize if results are reliable or not, and that blindly follow indications based on the data the device may have collected inaccurately. The same applies if indications are not adapted to the individual’s needs but are based on the general population.

They do have some issues regarding accuracy and it’s not very personal and when in regards health it’s kind of dangerous in my opinion. — ID8.

Another concern emerged from sharing personal data that could give the opportunity to other people to “harm” the participant (e.g., sharing the live location during training indicates that the home is probably empty, or sharing personal health information could be used as an advantage to insurance companies). Participants were often not fully aware of how data could be used, and they were further worried about improper use. Data privacy and sharing are crucial aspects when dealing with a great amount of different personal data, especially regarding health and lifestyle ones, especially if they are misused or shared for commercial purposes. With these types of data continuously collected and analysed, a complete and wide large-scale unauthorized monitoring might be carried out. Hence, in a negative scenario, these data might also be used not only for commercial purposes but also for large-scale harm or creating damages on community levels, not just to individuals. On the contrary, such an amount of data could be positively exploited for better meeting large-scale social needs and for creating new health and lifestyle policies. Thus, having clear statements about data protection and usage would be much appreciated. Even considering data and information used for marketing purposes, as they do not share meaning with health management.

If we’re moving to a society where your health data is collected and your insurance policies are made based upon your health collection, things like that … I wouldn’t like that—ID14.

Moreover, high costs of devices or premium features were seen as barriers, pushing adults to opt for simpler and cheaper alternatives which may lack important safety or emergency features. Finally, lack of personalization in apps and wearables was a common concern, as it limited their ability to fully adapt to individual needs in daily life.

I think it’s very general and I would like it to fit a bit more with my lifestyle so that I can see how I’m doing for my parameters and not like for the general kind of population—ID18.

Discussion

This study qualitatively investigated adults’ experiences using health apps and wearables, focusing on their motivations, concerns, and preferences. Adults enhanced the need for an easy and accurate tool that allows health management (Easy and accurate monitoring of health: balancing users’ needs and technological challenges), supporting and motivating them (Self-improvement and motivation: usefulness of rewarding behaviours and gamification towards achievements), while being customizable under different points of view (Requiring personalized apps and wearables: aesthetics and wearability). Additionally, they highlighted the role of apps and wearables for prevention (Beyond simple monitoring: prevention and care throughout daily life) while also mentioning potential negative aspects of using them (Awareness of potentially dangerous digital data world: from distress to fixation).

Theme 1

Our sample valued apps and wearables for easily managing and improving health, offering various benefits. The holistic approach of simultaneous and continuous monitoring of different health variables, including both medical and non-medical aspects, was considered highly advantageous, in line with previous evidence (Mobile Technology for Adaptive Aging, 2020). Seeing the interaction of different variables was crucial, as participants used this technology to become more informed about their health and were further empowered, similar to previous findings where adults reported adopting these technologies for obtaining health self-efficacy (Schroeder et al., 2024). Interestingly, from our study emerged that for managing their health, adults preferred seeing health variables trends over time rather than single measurements, emphasizing the importance of automatic continuous monitoring for raising awareness and promoting healthy lifestyles. On many occasions, participants stressed this concept, even though the data were very accurate, as health is an ongoing condition that evolves over time and should be interpreted considering a wider range of time rather than the singular day. As already explored in literature, having a long-term vision on this topic is important when considering both individual and collective health (Schermer et al., 2022). The singular day was reported to help accomplish small changes and gradually reach aims that led to bigger ones, but always to be considered with care.

Our sample stated that automation was beneficial in daily life, especially for older adults’ adoption of wearables, as already reported in a study (Nittas et al., 2019), as this helped them have data without the necessity for manual interaction or specific knowledge on how to make the device work (Venn et al., 2024). For those with cognitive impairments, objective data from these devices were also valuable in medical consultations, for caregivers and health professionals, enhancing the possibilities for effective home care, as also reported in the literature (Lazarou et al., 2021). Accurate data collection built trust in the devices, motivating users to monitor more health variables and understand the importance of consistent healthy habits, in line with previous findings (Schroeder et al., 2024).

Considering that our sample was composed on average of highly educated participants living in a developed country, this might have influenced results showing tendencies that may not apply in other countries. This might be especially true in people with low socio-economic conditions that face different barriers in technology adoption and use, internet access, tech literacy and costs (Al-Dhahir et al., 2022). Costs are a major barrier, in particular when considering that wearables can have different types of sensors based on their price and that influence their final costs. Additionally, the price linked for continuous internet access or for buying premium contents (e.g., additional functionalities, better explanation of parameters and personalized analysis) hinder technological adoption and use. Moreover, cultural aspects may play a role when considering health topics as they are influenced by both social and cultural elements (Hernandez et al., 2006).

Theme 2 and theme 3

Many participants adopted health apps and wearables out of curiosity, and in line with that educational and informative content was very appreciated, especially when professional. According to previous evidence from a study, these technologies could support health educational purposes by providing day-to-day sessions (Timmers et al., 2019). Many also aimed to improve their performances, thus learning and receiving personalized guidance on that was appreciated. Hence, the possibility to personalize apps and wearables towards different needs and situations was widely appreciated and deemed fundamental to help them be fully adaptable and suitable for different needs and situations. These characteristics were already deemed important in a previous study (Covi et al., 2021). Personalizing features, variables monitored, alarms set, reminders for completing aims and notifications for achievements reached were considered extra help and important to make the device straight to the point, user-friendly and motivating (Lazarou et al., 2021; Quazi & Malik, 2022). Gamification was a useful feature for engaging users and motivating them, particularly younger ones, by turning health tasks into enjoyable activities further leading to health improvements, as also reported in literature (Mamede et al., 2021; Pérez-López et al., 2022). Thus, gamification should be more emphasized in health apps and wearables for younger people.

Despite these benefits, several barriers that prevented adults from maximally exploiting apps and wearables for health were identified and need to be addressed. Barriers identified in our study matched those already identified as such: poor battery for continuous daily monitoring, privacy concerns, language and translations (Aboye et al., 2024), wearability (Jarusriboonchai & Häkkilä, 2019; Purnell et al., 2023) lack of integration that forced them to use different devices to have comprehensive health monitoring, and the necessity for manual input as many features were not automated. The last two elements are particularly hostile for older adults, as they might struggle to manage different apps or devices and easily have an overall health perspective.

Many participants found wearables uncomfortable at night, despite being interested in sleep data and how to improve it. Similarly, wearing them during sports was not always possible due to the possibility of damaging them or hurting themselves with the wearable, especially in combat sports, climbing or volleyball. In this way, valuable physical activity data were missing, and sports performance improvements were hindered, limiting the effectiveness of the device. Considering that a vast amount of apps and wearables adopted for health purposes are oriented towards sports and physical activity, developers should improve wearability possibilities during sports to ensure that people can register physical activity data without endangering the individual. The size and aesthetics of wearables were also key factors, also according to literature, as they could lead adults to wear them or not during daily life and occasions (Pateman et al., 2018), especially for women, resulting in a lack of useful data. Nonetheless, few participants accepted these aesthetical drawbacks for sports performance improvements. Furthermore, for older adults wearing a device that looked like a regular watch was even an advantage as it did not show a physical weakness or a chronic condition they had (e.g., the glucometer and diabetes). Considering that apps and wearables used to monitor lifestyle and different health domains (e.g., physical activity and diet) could also directly or indirectly collect and manage specific data (e.g., blood glucose and heart rate), they could represent a valuable alternative or support for medical devices for older adults with or without chronic conditions (Sproul et al., 2023).

Theme 4

In addition to other advantages of continuous monitoring of simple and complex health variables already present in literature such as glycaemia or electrocardiography (EKG) (Covi et al., 2021; Gambhir et al., 2021) participants appreciated that it allowed for the detection of abnormalities and emergency conditions, alerting them to prevent or treat dangerous situations. Similarly, another study reported that these possibilities are valued to foster health promotion and disease prevention (Nittas et al., 2019). Alert features were particularly important for older adults or those living alone, highlighting the role of apps and wearables in safety and prevention, for example, in fall detection and prevention or sports injuries or concussions, as reported in previous studies (Davies, 2021; Ranney et al., 2022). Thus, these devices could be adopted by family members to check and support the ones who need remote care. All these features supported the role these devices play in prevention, considered a crucial element for adults, thus suggesting their adoption for simultaneously pursuing sports performance improvements and health prevention for adults.

Theme 5

Adults in our sample and in previous studies reported some concerns regarding the security of data collected and their improper use, especially for health data (Alhammad et al., 2024; Mariani & Bouderhem, 2023; Rajput et al., 2023). In our sample, adults were willing to provide and share their health data as this could save their life in emergency situations, but they were not sure precisely how their data would have also been used and were worried that they could be used to hinder them (e.g., to deny an insurance policy). These concerns are similar to those previously explored in the same population (Oh et al., 2021; Schroeder et al., 2024). On one hand, sharing location data of someone living alone could help in case of emergency, on the other hand, it could endanger the individual letting other people know he’s alone or when the house is empty. Moreover, participants reported other potential negative aspects of dealing with health data collection and analysis, as already reported in literature concerning health data analysis (König et al., 2021), especially for manual input, but did not accuse the device itself but rather the ongoing psychological condition of the participants. They believed that using a device for registering weight data, for example, could not necessarily cause a fixation or an obsession but could more easily cause it in people who already have another fixation or are more prone to developing one. To solve this problem, our participants suggested that, when possible, a health professional educate the individual to correctly use the device and interpret data and their reliability. The same solution was already reported in literature to ensure data reliability (Kayyali et al., 2017).

Strengths and limitations

Some limitations in this work must be acknowledged. First, the sample was mainly composed of individuals with a high average educational background that might have influenced results, enhancing an interest in health-related topics, such as the one investigated in this study. Second, most of the students involved in this study were from the physiotherapy course, despite researchers’ efforts to involve students of other courses not health related. This might have further influenced results towards health topics. Additionally, efforts were made to reach people not involved in educational or working paths. Third, no participants above the age of 55 took part in the study, resulting in no information for this age group. Additionally, just one participant could be identified in the older adults category but due to its profession, information provided by him might be influenced by his job, as he was very informed on the topic compared to his corresponding age group. Thus, even for older adults no information can be retrieved.

While a strength of this work is that every participant used an app or a wearable for physical activity-related parameters and most of them also for mental health ones, diet was taken into account by only four participants, thus resulting in less information for this domain. Another strength is that the team of researchers that produce the semi-structured interview guide was made of different professionals, each one providing its own vision on the topic to gather as much information as possible. Moreover, another strength is that enough participants (6) can be identified in the young adults group (18–26 years old), to provide valuable information for this age group regarding their user-experience for apps and wearables aiming towards health variables.

Future perspectives

Future research should address broader samples for qualitative studies, including different populations using apps and wearables for health purposes. Moreover, a quantitative evaluation of the effectiveness of these technologies in improving their health outcomes over time should be included. Additionally, it could be useful to conduct qualitative studies in different populations to explore barriers to adoption and use of apps and wearables for health purposes, especially in younger adults and in older adults. Finally, future research should involve both apps and wearables addressed to a single health domain (e.g., diet and sleep) as well as multiple health domains (e.g., physical activity and diet).

Conclusions

In our sample, apps and wearables were considered highly effective in managing and improving health. They facilitated data collection and analysis, enabling individuals without health expertise to understand the benefits of a healthy lifestyle. These technologies supported consistent and personalized health improvements over time, motivating users with fun and educational features. Additionally, they were valued for safety and emergency features that could help prevent or manage dangerous situations. However, some negative aspects that hindered their use were identified, such as poor battery life, wearability issues and data privacy policies. Addressing these barriers might allow adults to use these technologies more extensively, further improving sports performance and health variables. Moreover, abnormal or incorrect data, manually inserting them or being advised to check the health status with a medical professional were elements of distress for our participants. In conclusion, apps and wearables were crucial tools for supporting health improvement programmes in our sample and could play a significant role in supporting active ageing initiatives for adults.

Authors’ contributions

GL, AS and MT identified the research question. GL and BG performed methodology; GL collected data. GL and FR analysed data. GL, FR and BG wrote the original draft. GL, FR, BG, AS and MT reviewed the manuscript. All authors read and approved the final manuscript.

Ethical approval

The ethical approval was obtained from the Medical Ethics Committee of the UZ Brussel (BUN: 1432023000314; EC-2023-372, approval date 28/02/2024).

Biographies

Gaia Leuzzi Graduated in Sports Science and Health (2019) and has a Master’s degree in Preventive and Adapted Physical Activity, both at the University of Genoa (2021). Currently, she is a joint PhD student at the University of Genoa and the Vrije Universiteit Brussel (VUB), in the field of Neurosciences curricula Clinical and Experimental, and Physical Education and Rehabilitation, in collaboration between REHElab and Swhard s.r.l.

Filippo Recenti He obtained a Bachelor’s degree in Physiotherapy in 2019 (University of Genoa) and a Master’s degree in Biostatistics in 2023 (University of Milan-Bicocca). Currently, he is working on a joint PhD in co-tutoring with the University of Genoa and Lund University (Sweden).

Benedetto Giardulli He obtained his bachelor’s degree in physiotherapy in 2017 (University of Campania Luigi Vanvitelli) and the master’s degree in “Rehabilitative Sciences of the Health Professions” in 2019 (University of Naples Federico II). In 2021, he graduated from the “Medtronic Master Advanced Knowledge Experience” (MAKE Napoli). Currently, he is a PhD student at the University of Genoa.

Aldo Scafoglieri he is an assistant professor at the Vrije Universiteit Brussel. He is also a member of the Frailty in Aging research group. He is the director of the Master-after-Master, Postgraduate and International Manual Therapy programmes. Moreover, he is an expert in functional body composition and biomechanics research methodology.

Marco Testa he is a full professor at the University of Genova and a physiotherapist with a PhD in Rehabilitation Sciences and Physiotherapy. Currently, he is head of the Master in Rehabilitation of Musculoskeletal Disorders of the University of Genova and President of the Campus of Savona.

Funding Statement

The author(s) reported there is no funding associated with the work featured in this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data available on reasonable request from the authors.

Consent to publication

All participants gave their consent for publication.

Consent to participate

All participants read and signed the informed consent form prior to participating.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17482631.2024.2447096