Health wearables: Is there cause for concern?

Wearables have done an excellent job of marrying technology and a healthy lifestyle very successfully. Image: Shutterstock

A few years ago, a man called Bob Burdett's life was saved by his smartwatch. Bob, who would meet his son that day, lay unconscious after flipping his bike. In the meantime, his watch had detected the fall and informed 911 to do the needful. Bob's son Gabe got messages with updated locations of his father—right from the point of the accident to the hospital. The incident duly went viral, carrying an extraordinary validation of what smartwatches could do and giving us some clues about the thinking of an 'average' user of a hi-tech wearable. It was revealed that Bob had taken care to turn 'hard fall detection' on in his smartwatch and had also listed Gabe as an emergency contact. Does this hint at any more strands of user psychology that go into wearable use?

mHealth or mobile health is a term for using wireless technology like mobile devices in the practice or pursuit of health. The health devices market is growing rapidly at 27 percent annually. Most mHealth users say that the wearable helps them to create a healthy lifestyle comprising of eating well, sleeping properly, and exercising daily. The quantified self, representing oneself in relevant data points, has been used to describe mass self-tracking behaviour. In the health and fitness domain, relevant data points are blood pressure, heart rate, respiratory rate, sleep pattern, activity level, and temperature, among others. The wearable user monitors her health through these metrics and uses them as the basis for a healthy lifestyle.

The motivation for using health wearables is layered

A bird's eye view would suggest that pursuing the quantified self is congruent with modern society's love and familiarity with data. The predominant idiom of our time rests somewhere between 'what cannot be measured cannot be improved' to its more popular derivative 'what cannot be counted doesn't count'. This is especially true for the white-collar professional whose day-to-day life involves lots of numbers and counting: from boarding the subway in the nick of time, preparing a deck seasoned with appropriate statistics to convince a room full of bosses, tracking the KPIs on which her bonuses payout, or even watching one's net worth in different assets. A smartwatch is a reasonable and seamless fit in this drill.

Wearable use may also have other motivations that we may take an evidence-based guess at. For example, a wearable may depict a valuable cross between conventional and corporate fashion senses. Some users might derive gratification from a wearable that may be tied to self-perception, i.e. helping a user fulfil motivations they have not previously been aware of. An example of a latent motivation is to appear busy or health-conscious because people sometimes perceive users of products indicating busyness or health as important and impressive. Simpler motivations could be at work, too. For example, a user's wearable might be helping her elicit utility from situations like going about a sprawling office complex between meetings. It is also known, for example, that users respond better to the same application on their phone than to their PC—the same might happen to wearables, with users wanting to avoid the information overload or dependency they perceive vis-a-vis the smartphone.

Finally, some users may be more disposed to use a fitness-tracking wearable than others, even beyond mere willingness to pay for a device or the inherent importance of fitness in the user's lifestyle. One may imagine an ideal wearable user to have what psychologists call a systematic cognitive style, defined by a step-by-step approach to thinking and careful planning. A systematic style correlates positively with a trait called conscientiousness. A conscientious person is diligent, can control impulsive actions like binge eating relatively better, plans ahead, can delay gratification, and is known to reflect organisation, responsibility, and self-discipline. These characteristics may even correlate with a successful, goal-oriented urban lifestyle.

Unsurprisingly, researchers have seen conscientiousness, a significant predictor of health and longevity, relate to self-tracking. These internal standards may, in turn, result from the challenging goals they routinely encounter at work or in family relationships, including long-range goals like career, sales, or institution-building. Some may even perceive an objectively healthy lifestyle as 'low-hanging fruit' compared to these other long-range, complex objectives.

After these motivations have triggered usage, the user's intention to keep using it makes a technology successful in adoption terms. The Unified Theory of Acceptance and Use of Technology (UTAUT) is widely used as a theoretical basis to understand this. It says that performance expectancy (Will the smartwatch improve my health?), effort expectancy (How easy is it to use?), social influence (Do others think I should use it?), and certain facilitating conditions (like a culture of self-tracking or exercise in public places) will predict a technology's adoption and sustained use. Largely, health wearables fare well on all four accounts.

Also read: Why doctors are critical to digital health deployments

The blind turn

Business pundits point out that a microscopic product-user fit must precede a broader product-market fit. However, frameworks to understand product-user fit tend to be static and do little to consider the dynamic relationship between the user and the product, which changes over time.

We give an example here. Users take to fitness-tracking enthusiastically, but in short order, they may find themselves nursing a dependency. The internet is rife with stories of anxious users unable to meet health goals, often unrealistic ones, set by their smart trackers. Users may perceive a physical exercise session as invalid if their device fails to record it due to a glitch. The self-determination theory of human motivation tells us that the factors of autonomy—the feeling that one has a choice in one's behaviour—and relatedness—a sense of belongingness with others—are key to the enjoyable use of a device or product. Yet, autonomy and relatedness may be compromised due to the negative emotions of a possible wearable dependency. Relatedness could be tied to the 'social influence' factor in UTAUT since it diminishes if one perceives oneself unfavourably regarding body image in the social or peer group.

On the flip side, the user may begin registering the recurring notifications beeped out by the wearable as interruptions to her daily life. This can be related to research showing that personalised mobile messages with person-specific guidance don't have desirable effects on app engagement. Recall the conscientiousness of a person's systematic cognitive style: Conscientious people may experience greater dips in satisfaction and proportionally higher levels of stress or stress-related failure compared to others. Could it be that the goal-focused nature of a conscientious user helps her overcome these worries amplified by health wearable use, possibly due to better planning using fine-grained data? Or would it lead her to quicker discontinuance of the wearable?

Designers pay attention to factors like usefulness, ease of use, behavioural change techniques, and a wearable's flow or 'customer delight' experience to enhance the user's experience. While these factors predict a user's intention to continue using a mHealth product, what catalyses their satisfaction level with a device is worth noting. Satisfaction is a particularly important attribute that could be harmed by factors such as dependency or anxiety related to the health goals not being achieved, however good the device is perceived to be. For example, how satisfied a user is with the utility or features of a device depends on how health-conscious she has been and is at the moment. This works in different ways in different settings. For example, a less health-conscious user will credit the immersive experience offered by a smartwatch for adopting healthy habits and feeling satisfied enough to continue using it. The same user's health consciousness may increase over long-term use of the wearable, and the experience previously considered immersive might be perceived as insufficient, affecting satisfaction.  

Wearables have done an excellent job of marrying technology and a healthy lifestyle very successfully. Yet, suppose a critical mass of users begins to experience annoyance with their devices and discontinues their use. In that case, the health wearable industry may lose the sheen and the associated USPs and use cases. Compared to casual wearers, the conundrum here is that many faithful wearable users might endure a worse experience due to dependency or sensitivity to privacy. Many may have discarded tangible sources of exercise like intensive sport, the cross trainer, or the treadmill in favour of a wearable to grow healthy habits. They might feel caught between a rock and a hard place.

Mohammed Shahid Abdulla, faculty member, IIM Kozhikode and Manoshij Banerjee, an independent consultant on the digital workplace