| Participant/Patient |
Technology knowledge and skills and other individual barriers Access to necessary technology for device to function (i.e., smartphone, tablet, computer) Willingness to wear/burden of data collection Motivation for behavior change Adherence to wearable protocols Reactivity to wearing the device in observational studies Desensitization to feedback in intervention protocols Habituation or loss of enthusiasm as the device’s novelty wanes Inability to afford wearable device May not provide enough of an impetus for significant behavior change and maintenance
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Conduct preliminary assessment to understand context and needs of study or clinical population to determine device feasibility/acceptability and identify pragmatic barriers to adherence Utilize a co-design approach to intervention development that employs a range of participatory methods to develop interventions that are feasible and acceptable to end-users. Develop strategies to overcome identified barriers to wearable usage and adherence (e.g., providing smartphone, paying for data usage costs, avoiding devices that require a smartphone rather than a standard computer, setting up effective reminder systems, choosing a device with a longer battery life, etc.) Ensure tracker is part of an engaging overall study approach Providing external prompts or reminders to ensure compliance as needed Provide clear instructions as to how much wear time is requested, the battery life, and the desired frequency of syncing Check-in with patients and participants regularly to ensure they are not having any issues For interventions, provide a phased approach to “unlocking” intervention features Conduct research to determine the extent of reactivity to wearable devices and whether and how this reactivity dissipates according to the duration of the wear period (e.g., 1 week versus 1 month) or the use of repeated wear periods (1 week at three separate time points) Work with device manufacturers, employers, insurers, and healthcare systems to create programs to provide financial assistance or free devices to all individuals or those who are unable to afford wearables Determine which individuals are non-responsive and may need additional augmentation strategies, which augmentation strategies are most efficacious and cost-effective, and what the optimal timing is for delivering these augmentation strategies
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| Device |
Accuracy of PA assessment and intensity classification and inability to distinguish between postures (i.e., sitting, standing, lying) Provision of clear, meaningful data that can be easily and accurately interpreted Inequivalent metrics output by devices (most commonly) and public health recommendations for physical activity (minutes of moderate to vigorous intensity PA) Length of time required to conduct a traditional, rigorous validation study Rapid evolution of device design, features, user interface and software that is controlled by manufacturer Proprietary algorithms and limited access to raw data Features including durability, ease of use, battery life Cost Technology failures
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Conduct research to understand the accuracy of wearables in comparison to research-grade accelerometers using more rapid research designs Include clinicians and patients in development of feedback associated with device Conduct research to convert output data from wearable to public health recommendations or work with device manufacturers to refine output metrics to make them meaningful Coverage of device costs by insurer or employer Establish best practices for analyzing and storing data
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| Clinical/Research setting |
Ease with which data can be aggregated and harmonized Development of effective and accurate algorithms Education of clinical team Integration with EHRs Actionable reports for clinical/research staff Efficacy/effectiveness of devices to change and maintain behavior without high level of oversight by research/clinical staff
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Understand how to effectively integrate wearable data in EHRs so data are actionable by clinicians Establish best practices for combing wearable data with other data and for storing, processing, and analyzing these data Create standards for interpreting and processing data Determine how wearable data can be incorporated into clinic flow without creating unnecessary burden Develop educational materials and training to teach clinicians how to view, interpret, and act upon patient-generated data Develop staffing, reimbursement, and other structural support to facilitate usage of data Conduct interventions to assess the efficacy of device, alone, to change and maintain activity in patients with a variety of chronic conditions
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