In an more and more related world, cell units have grow to be ubiquitous1. Wearable units, together with health trackers (referred to all through the paper as “wearables” and “health trackers” interchangeably), present practically steady info on bodily exercise, coronary heart price, and sleep. As use will increase, knowledge are more and more built-in into medical and analysis settings. There may be rising proof that health trackers can establish modifications in coronary heart price variability, probably figuring out COVID-19 onset previous to a medical prognosis2. Nevertheless, there’s a lack of variety in research utilizing wearables to check well being outcomes3. Regardless of a rise in broadband and smartphone possession and use throughout the US, entry to digital well being applied sciences in lower-income households lags behind center and upper-income households4. Improved entry to digital infrastructure and units in numerous communities is required to keep away from the danger of digital applied sciences changing into one other social determinant of well being5.
One of many core values of the Nationwide Institutes of Well being’s (NIH’s) All of Us Analysis Program is variety in all elements of this system, together with contributors, consortium members, program employees, and researchers6. Range of the underlying knowledge from contributors is vital for lowering bias in precision medication analysis, which goals to find greatest medical practices on the particular person, not inhabitants, degree. This system welcomes contributors from all backgrounds and goals to replicate the wealthy variety of the US by enrolling individuals from communities which might be traditionally underrepresented in biomedical analysis (UBR), resembling racial and ethnic minority teams and people with restricted entry to medical care7. Recognizing the worth of digital well being applied sciences for analysis and well being, this system launched Fitbit Deliver-Your-Personal-System (BYOD), enabling contributors to donate their Fitbit knowledge to this system8. Nevertheless, when All of Us Fitbit participant demographics had been in comparison with all program contributors, a discount in variety in race and socioeconomic standing was famous9. This research was designed to achieve numerous communities served by Federally Certified Well being Facilities (FQHCs) to know the gaps to participation in Fitbit BYOD.
To bridge this data hole, six FQHCs which might be additionally part of the All of Us Consortium carried out a survey to gather sufferers’ demographic info, curiosity in having a health tracker, and different components probably related to this curiosity. Descriptive statistics, univariate and multivariate logistic regression, and qualitative evaluation of free-text responses had been used to research the outcomes (see “Strategies” for particulars; see Supplementary Fig. 1 for a map of collaborating FQHC websites).
Of the 1007 adults surveyed, 39% recognized as Hispanic, 36% as non-Hispanic Black or African American, and 15% as non-Hispanic White (Fig. 1). Virtually three-quarters recognized as cis-gender girls (71%), 14% had lower than a Ninth-grade schooling whereas 45% had accomplished highschool, and contributors had been evenly divided throughout age teams. The surveys had been administered in English (68%) and Spanish (32%). The first consequence was whether or not contributors would really like a health tracker, and total 58% responded “sure,” 20% “no,” and 23% didn’t reply (Fig. 1).
Tables present the race/ethnicity, schooling, age, and intercourse/gender traits of the survey respondents. Pie charts evaluate the schooling ranges and race/ethnicity of the survey respondents to All of Us Analysis Program contributors. Some All of Us contributors are FQHC sufferers and should have taken half on this survey, however not all survey respondents are enrolled in All of Us.
Individuals had been requested a wide range of questions on their publicity to, possession of, curiosity in, and familiarity with health trackers. Determine 2 shows contributors’ possession price and curiosity in health trackers. Individuals had been requested about boundaries to proudly owning a health tracker. These “Hindering components” embody value, a basic consciousness of health trackers, and particular details about how they’ll present well being insights, language, and help over the cellphone vs absolutely digital strategies. Respondents had been additionally requested about useful components for utilizing health trackers, mixed beneath “Serving to components” as suggestions for potential strategies to mitigate disparities in digital well being know-how use. These embody an curiosity in having a tool and studying about how health trackers can be utilized to trace well being, a willingness to share knowledge for analysis, proudly owning a smartphone and information of find out how to obtain and use apps, and an curiosity in studying extra.
Individuals had been requested a wide range of questions centered round their publicity to, possession of, curiosity in, and familiarity with health trackers. The highest two pie charts illustrate contributors’ possession and curiosity in health trackers. Individuals had been additionally requested what sorts of issues get in the best way of proudly owning a health tracker. These gadgets had been distilled and are listed beneath “Hindering components.” Respondents had been additionally requested about components that they might contemplate useful in lowering boundaries to utilizing a health tracker, mixed beneath “Serving to components” as suggestions for potential strategies to mitigate disparities in digital well being know-how use.
Quite a lot of components had been related to “would you want a health tracker” on the 0.05 significance degree utilizing two-sided exams (Desk 1). Individuals who responded they want a health tracker had increased odds in univariate logistic regression fashions of figuring out as a cis girl (odds ratio (OR) = 2.13, 95% CI:1.50–3.04, P < 0.001), being a participant from the Cooperative Well being 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 figuring out what a health tracker is earlier than taking the survey (OR = 1.79, 95% CI:1.29–2.49, P < 0.001). Within the multivariate logistic regression mannequin, contributors who would really like a health tracker had been extra prone to be among the many 46–55 and 56–65 age teams and recognized as non-Hispanic Black or African American. Individuals who had a smartphone on the time of the survey and knew what a health tracker was earlier than the survey had been additionally extra prone to need a health tracker. Not having a health tracker as a result of they “are too costly” and “don’t perceive the way it can assist contributors, however need to be taught” had been additionally related to answering sure to, “would you want to make use of a health tracker?” Not having a health tracker as a result of “they aren’t useful” or “don’t need to decide to utilizing it daily” had been related to answering “no.” These components, together with schooling and coaching on the worth of those units, might be thought-about when designing analysis research and packages to enhance digital well being fairness.
Outcomes from a qualitative content material evaluation had been according to the quantitative findings. The highest three themes had been “no curiosity,” “lack of awareness,” and “misplaced/damaged system.” Over half of the qualitative responses to “why don’t you’ve gotten a health tracker” had been coded as “No Curiosity” (52%, e.g.,: “I’ve by no means considered having one,” “by no means thought-about it”). This will likely even be a results of restricted consciousness or information of potential well being impacts. Different widespread responses fell beneath the theme of lack of awareness (18%, e.g.,: “didn’t know what they had been”). Whereas value was not recognized as a predominant theme among the many open-ended questions, “misplaced/damaged system” was prevalent, suggesting that value could also be a barrier to changing a beforehand owned system. Our findings recommend that widespread adoption and use of digital well being units are potential throughout numerous communities, however would require a high-touch method, together with instructional supplies and public or non-public monetary funding in units. Limitations of the research embody the surveyed affected person pattern will not be absolutely consultant of the affected person inhabitants of the six FQHCs, and the dearth of a second parallel reviewer within the qualitative evaluation.
Nearly all of sufferers surveyed are considering utilizing digital well being units and studying how these units might enhance well being. Nevertheless, value and understanding how they work are essential boundaries that might stop people from realizing the advantages of wearable digital well being units resembling health trackers (Fig. 2). Consideration of cultural nuances are additionally essential, for instance with the terminology used to call these units. In the midst of this research, we discovered that many Spanish-speaking contributors had been involved that these units might be used to trace their actions, due to the phrase “trackers.” With the rise in telehealth and telemedicine use because of the COVID pandemic, entry to digital well being applied sciences is more and more essential. Nevertheless, as the usage of digital know-how expands into well being care, cautious consideration is required to make sure that current well being fairness gaps will not be exacerbated and extra well being fairness gaps will not be created.
Whereas research have been carried out on the usage of wearables, only a few have particularly sought enter from UBR populations. On this research, sufferers got the choice to finish the survey in English or Spanish; one-third accomplished in Spanish. A Pew Analysis research10 discovered 21% of Individuals use smartwatches or wearable health trackers. Use was higher for these with the next annual family revenue and people figuring out as white and/or non-Hispanic. Greater than 65% of the Pew survey contributors recognized as white and had an annual family revenue higher than $30 Okay per 12 months. In distinction, over 70% of contributors in our survey don’t establish as white (36% establish as Black or African American in comparison with 10% within the Pew research, and 39% establish as Hispanic in comparison with 14% within the Pew research). Primarily based on well being heart knowledge, 90% of the sufferers at our recruitment facilities have an annual revenue at or beneath 200% of the Federal Poverty Guideline. Information collected from FQHC All of Us contributors point out that 38.3% have an annual revenue of lower than $10 Okay, 23.9% have incomes between $10 and $25 Okay, and seven.9% between $25 and $35 Okay, with 21.7% preferring to not reply. Our outcomes align with current findings by Tappen et al11, the place vital variations in laptop possession, web entry, and use of digital well being info had been noticed amongst older racial and ethnic minority people when in comparison with white adults of comparable ages. Older age, decrease schooling, lower-income, and minority racial and ethnicity identification predicted restricted digital well being info use11.
Wearables are evolving to watch extra particular well being issues, together with diabetes and coronary heart illness, two situations which might be prevalent in African American and Hispanic communities. Inclusive use of digital well being applied sciences in analysis and medical observe will seemingly require strategic planning for units, infrastructure, and schooling about digital well being applied sciences. Most people surveyed have smartphones and know find out how to set up apps, however would profit from further info on how health trackers can be utilized to enhance well being. Since the price of a tool was one of the hindering components famous within the survey, funding is required to assist overcome this barrier to entry. There’s a threat of accelerating well being disparities by means of noninclusion in analysis and medical care utilizing wearables and different digital well being units; the varied contributors on this research indicated curiosity in health trackers, however boundaries resembling value and schooling exist. Future analysis to know potential well being disparities and inequity might examine different evidence-based digital well being options and real-world knowledge past health trackers. The All of Us program is dedicated to participating with numerous communities and constructing relationships with group leaders with a view to acquire belief, however is just one analysis program. The outcomes of this survey recommend that further funding in units and academic supplies from different medical and analysis packages might contribute towards lowering disparities.
