Exploring Families' Acceptance of Wearable Activity Trackers: A Mixed-Methods Study

Moving together: Increasing physical activity in older adults with an intergenerational technology-based intervention. A feasibility study

Robust evidence supports the role of physical activity and exercise in increasing longevity, decreasing morbidity and helping older adults maintain the highest quality of life attainable. However, the majority of older adults are not sufficiently physically active and interventions are needed to change their behaviors. Familial or intergenerational contact has been positively linked to health and well-being in older adults. Therefore, this study aimed to i) establish acceptability and test the functionality and useability of a novel technology-driven intergenerational intervention targeting physical activity and age stereotypes, and ii) identify any potential issues with recruitment and retention. Four familial dyads (adult ≥ 65 and child 7-11 years) engaged with the intervention. Working collaboratively during a four-week trial, they combined daily step-counts (acquired via any activity of their choice, using PA trackers) to complete a virtual walk route using online platform World Walking. Thematic analysis of three post-intervention focus groups (one older adult; one child; one additional parental cohort) identified eight subthemes: Engagement; Provision of a Positive Experience; Participant Stimuli; Generated Outcomes; Operationality; Limitations; Mediators; Facilitators, and Perceptions. Participants enjoyed and successfully engaged with the intervention; when designing behaviour change interventions for older adults, flexibility within pre-established routines, individual choice, and avoiding rigidly imposed structures, is important. Strategies to challenge negative perceptions of older adults' engagement with technology and PA should be integrated into recruitment processes.

Parents' Perceptions of Children's and Adolescents' Use of Electronic Devices to Promote Physical Activity: Systematic Review of Qualitative Evidence

BACKGROUND

The use of physical activity (PA) electronic devices offers a unique opportunity to engage children and adolescents in PA. For this age group (2-17 years), parents play a key role in promoting healthy lifestyles and regulating the use of electronic devices. Therefore, parents' perceptions of the use of electronic devices for PA in children and adolescents are critical for efficient intervention.

OBJECTIVE

The aim of this qualitative systematic review was to improve the understanding of parents' perceptions of the use of electronic devices for PA in children and adolescents.

METHODS

A systematic search of electronic databases (Medline/PubMed, SPORTDiscus, Web of Science, Scopus, OpenGrey, and Deep Blue) was conducted. Studies from inception (2010) to May 2022 were identified. Qualitative studies on the perceptions of healthy children's and adolescents' (aged 2-17 years) parents regarding PA interventions performed on electronic devices were included according to the Cochrane Qualitative and Implementation Methods Group Guidance Series and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used for methodological validity.

RESULTS

In total, 18 studies with 410 parents, mostly mothers, were included. Parents' perceptions were grouped into 4 categories: usefulness, advantages, general perceptions (electronic devices for health promotion, preferences for real-life PA, and concerns), and acceptability (barriers and facilitators) of electronic devices for PA. Parents perceived electronic devices as useful for increasing PA, learning new skills, and increasing motivation for PA and valued those devices that promoted socialization and family and peer bonding. In terms of general perceptions, parents had positive attitudes toward PA electronic devices; however, they preferred outdoor and real-life PA, especially for preschoolers and children. Concerns, such as physical and psychological harm, addiction, conflicts, and compliance difficulties, were found. Facilitators were identified as ease of use, appropriate feedback, promotion of socialization, and motivational strategies, such as rewards, challenges, and attractiveness. Barriers, such as discomfort, price, and difficulties in using or understanding electronic devices, were also identified. For older children and adolescents, parents were more concerned about high levels of screen time and setting limits on electronic devices and therefore preferred PA electronic devices rather than traditional ones.

CONCLUSIONS

Overall, the participants had positive attitudes toward electronic devices for PA and perceived them as an effective way to promote PA in children and adolescents. They also perceived several benefits of using electronic devices, such as health promotion, increased awareness and motivation, and socialization, as well as barriers, facilitators, and age differences. The results of this study could provide researchers with insights into designing more effective, age-appropriate PA electronic devices for children and adolescents and improving adherence to their use.

TRIAL REGISTRATION

PROSPERO CRD42021292340; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=292340.

The development of a family-based wearable intervention using behaviour change and co-design approaches: move and connect

BACKGROUND

Previous research has explored the effectiveness of wearable activity trackers (wearables) for increasing child physical activity (PA) levels, but there have been mixed results. The use of theoretical frameworks and co-design techniques are recognised ways of increasing an intervention's acceptability and effectiveness.

AIMS

This study aims to use co-design workshops and an evidence-based theoretical framework (the Behaviour Change Wheel) to develop a family-based PA intervention using wearables.

METHODS

Three stages of intervention development outlined by the Behaviour Change Wheel were used. Co-design workshops with seven families (11 parents and 12 children) and seven PA experts were conducted where stakeholders discussed how to overcome previously identified barriers to families being active and using wearables. This resulted in the intervention's components being developed, with each component's mechanisms of action (e.g. intervention functions and behaviour change techniques) being retrospectively identified.

RESULTS

The 'Move & Connect' intervention was developed, which targets family PA and wearable use. The intervention takes a flexible approach and includes eight components, including wearable devices (Fitbit Alta HR), support resources, an introductory workshop, collective challenges, goal setting and reviewing, engagement prompts, social support and health-related resources (e.g. educational videos). The intervention incorporates six intervention functions targeting PA and wearable use: education, training, modelling, persuasion, incentivisation and environmental restructuring and 24 behaviour change techniques, including goal setting, social comparison, feedback on behaviour and graded task.

CONCLUSIONS

This is the first known study to use an evidence-based framework and co-design to develop a family-based wearable intervention. The identification of the intervention's mechanisms of action will prove useful when implementing and evaluating the 'Move & Connect' intervention and allow researchers to replicate its components.

Experience and Satisfaction with a Family-Based Physical Activity Intervention Using Activity Trackers and Apps: A Qualitative Study

Wearable activity trackers and smartphone apps have been shown to increase physical activity in children and adults. However, interventions using activity trackers and apps have rarely been tested in whole families. This study examined the experience and satisfaction with an activity tracker and app intervention (Step it Up Family) to increase physical activity in whole families. Telephone interviews were conducted with Queensland-based families (n = 19) who participated in the Step it Up Family intervention (N = 40, single-arm, pre/post feasibility study) in 2017/2018. Using commercial activity trackers combined with apps, the intervention included an introductory session, individual and family-level goal setting, self-monitoring, family step challenges, and weekly motivational text messages. Qualitative content analysis was conducted to identify themes, categories and sub-categories. In summary, parents reported that children were engaged with the activity tracker and app features to reach their daily step goals. Some technical difficulties were experienced with app navigation, syncing of activity tracker data, and tracker band discomfort. Although families liked that the weekly text messages reminded them to be active, they did not find them very motivating. Using text messages for physical activity motivation in families requires further testing. Overall, the intervention was well-received by families for increasing physical activity motivation.

Benefits of a Wearable Activity Tracker with Safety Features for Older Adults: An Intervention Study

Accidental falls and physical inactivity are important age-related issues for which smart technologies have demonstrated potential utility. This research aimed to explore the benefits of combining wearable activity monitors and telecare for older adults. A four-month interventional study was conducted between June 2021 and February 2022 in Slovenia. A purposive sample of 22 dyads of older adults aged 60 years and over and their relatives or family members used a wearable GoLiveClip device. The Pillar Integration Process was used to analyze the quantitative and qualitative data. Seven pillars emerged: (1) the use of smart technologies as a motivator for physical activity; (2) factors related to smart technology use affecting physical activity levels; (3) increased usefulness of smart technologies for users who completed the study; (4) activity monitoring as the most useful functionality of the solution; (5) the influence of technical problems on usefulness; (6) the influence of age and previous experience with smart technologies on usefulness; and (7) moderate psychological effects of smart technology use. Activity trackers were found to effectively promote physical activity in older adults, and safety features were shown to be an important part of the solution, regardless of health status or physical activity level.

The Use of Wearable Activity Trackers in Schools to Promote Child and Adolescent Physical Activity: A Descriptive Content Analysis of School Staff's Perspectives

BACKGROUND

The school environment is an ideal setting for promoting physical activity (PA). Wearable activity trackers (wearables) have previously been implemented, in research, as intervention tools within the school-environment. However, the large-scale use and acceptance of wearables, in schools, is unknown.

METHODS

This study distributed a cross-sectional survey to school staff to investigate the prevalence of child and adolescent wearable use in schools, including when and how they are used, and school staff's willingness to use them in the future (as implemented by school staff). This survey consisted of between 13 and 22 items, including closed-ended and open-ended questions. Closed-ended responses were displayed descriptively (wearable prevalence and characteristics), and open-ended qualitative responses were categorised using descriptive content analysis (how wearables are used).

RESULTS

1087 school staff provided valid responses. Of those, 896 (82.4%) had never used a wearable as a teaching or support tool for their students, and 120 (11%) currently used- and 71 (6.5%) had previously used- a wearable as a teaching or support tool for their students. When wearables were used, school staff implemented their use regularly and during physical education lessons or throughout the entire school day. Wearables were used to monitor or increase student's PA levels, or for student and staff educational purposes (e.g., academic learning, movement breaks). Most school staff were willing to use a wearable as a teaching or support tool to promote student's PA, and/or learning about PA, in the future.

CONCLUSIONS

This study is the first study to explore the widescale use and acceptance of children and adolescents using wearables in the school-setting. Findings may inform the development of future school-based interventions and public health initiatives for physical activity promotion, using wearables.

Applying the COM-B model to understand wearable activity tracker use in children and adolescents

Aim

Wearable activity trackers (wearables) are increasingly popular intervention tools for increasing child and adolescent physical activity (PA) levels. However, the large-scale habitual use of wearables in children and adolescents is unknown. This study investigated the prevalence of wearable use in children and adolescents, and what factors impact their use.

Subjects and methods

This study utilised a cross-sectional survey and the ‘Capability, Opportunity, Motivation and Behaviour’ (COM-B) model was applied to explore what child/adolescent and parental characteristics impact wearable use. Parents/guardians of 5- to 17-year-olds were invited to complete the survey. The survey was open internationally, and consisted of between 19 and 23 questions, depending on child/adolescent wearable use. Multinomial logistic regression analyses were conducted to explore variables impacting wearable use, in children (5 to 9 years) and adolescents (10 to 17 years).

Results

The survey was completed by 652 parents, representing 831 children/adolescents. Most children/adolescents had never used a wearable (n = 429; 51.6%), and 252 (30.3%) and 150 (18.1%) currently or had previously used a wearable, respectively. Child age and sex, capability, opportunity and motivation for PA were associated with wearable use, and differences were present between child (5 to 9 years) and adolescent (10 to 17 years) wearable use.

Conclusions

This study offers a novel contribution to the understanding of child and adolescent habitual wearable use, and what impacts wearable use in these age groups.