In an progressively connected earth, mobile equipment have develop into ubiquitous1. Wearable units, including physical fitness trackers (referred to all over the paper as “wearables” and “fitness trackers” interchangeably), present just about ongoing info on actual physical activity, heart rate, and rest. As use increases, knowledge are significantly integrated into medical and analysis configurations. There is emerging evidence that exercise trackers can recognize adjustments in coronary heart level variability, potentially pinpointing COVID-19 onset prior to a medical analysis2. On the other hand, there is a deficiency of variety in scientific studies employing wearables to analyze wellbeing results3. In spite of an raise in broadband and smartphone possession and use throughout the United States, entry to digital overall health systems in lessen-cash flow homes lags at the rear of middle and higher-income households4. Improved accessibility to electronic infrastructure and devices in various communities is wanted to stay away from the chance of digital systems becoming an additional social determinant of overall health5.
One particular of the core values of the Countrywide Institutes of Health’s (NIH’s) All of Us Research System is range in all facets of the system, which include contributors, consortium members, application staff members, and scientists6. Variety of the fundamental info from participants is essential for lessening bias in precision medication research, which aims to learn ideal medical procedures at the particular person, not populace, stage. The program welcomes members from all backgrounds and aims to mirror the rich diversity of the United States by enrolling people today from communities that are historically underrepresented in biomedical investigation (UBR), these types of as racial and ethnic minority groups and those people with constrained entry to medical care7. Recognizing the worth of digital overall health systems for investigate and wellness, the software launched Fitbit Deliver-Your-Have-Gadget (BYOD), enabling individuals to donate their Fitbit data to the system8. Even so, when All of Us Fitbit participant demographics have been as opposed to all system members, a reduction in range in race and socioeconomic position was noted9. This study was developed to reach assorted communities served by Federally Experienced Overall health Facilities (FQHCs) to fully grasp the gaps to participation in Fitbit BYOD.
To bridge this awareness hole, six FQHCs that are also a section of the All of Us Consortium executed a study to obtain patients’ demographic data, curiosity in having a physical fitness tracker, and other things perhaps connected with this desire. Descriptive figures, univariate and multivariate logistic regression, and qualitative assessment of totally free-text responses were utilized to review the benefits (see “Methods” for particulars see Supplementary Fig. 1 for a map of participating FQHC internet sites).
Of the 1007 grownups surveyed, 39% discovered as Hispanic, 36% as non-Hispanic Black or African American, and 15% as non-Hispanic White (Fig. 1). Virtually a few-quarters discovered as cis-gender girls (71%), 14% had considerably less than a 9th-grade instruction when 45% had concluded significant faculty, and individuals have been evenly divided across age groups. The surveys were administered in English (68%) and Spanish (32%). The major final result was no matter whether members would like a exercise tracker, and general 58% responded “yes,” 20% “no,” and 23% did not remedy (Fig. 1).
Individuals were questioned a range of concerns about their exposure to, ownership of, curiosity in, and familiarity with fitness trackers. Determine 2 shows participants’ ownership rate and fascination in exercise trackers. Members were asked about limitations to owning a fitness tracker. These “Hindering factors” incorporate cost, a standard awareness of health and fitness trackers, and certain details about how they can deliver wellness insights, language, and guidance over the cellular phone vs entirely digital methods. Respondents were being also requested about beneficial factors for working with health trackers, put together beneath “Helping factors” as suggestions for probable procedures to mitigate disparities in electronic health know-how use. These include an interest in acquiring a machine and learning about how exercise trackers can be used to track wellness, a willingness to share knowledge for research, owning a smartphone and know-how of how to download and use applications, and an desire in learning a lot more.
A range of elements have been connected with “would you like a exercise tracker” at the .05 importance level applying two-sided checks (Table 1). Members who responded they would like a fitness tracker experienced bigger odds in univariate logistic regression designs of figuring out as a cis lady (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.