Original ResearchDIGITAL [602648]

Original ResearchDIGITAL
HEALTH
Health professionals’ attitudes to patients’ use
of wearable technology
Angus Watt1,Katherine Swainston1and Gemma Wilson2
Abstract
Objective: Wearable technologies for health monitoring are becoming increasingly mainstream. However, there is currently
limited evidence exploring use from the perspective of healthcare professionals. This study aimed to explore healthprofessionals’ attitudes toward their patients’ use of wearable technologies.
Methods: A convenience sample of health professionals was recruited to participate in this study. Qualitative
semi-structured interviews were carried out either face-to-face, via Skype or telephone. Interviews were recorded using
a Dictaphone, transcribed verbatim and analysed using thematic analysis.
Results: Four themes emerged from the qualitative findings: ‘opportunities for wearable technology’ , ‘usability and
understanding’ , ‘privacy and surveillance’ and ‘cost’ .
Conclusions: The findings portray health professionals’ ambivalence to the use of wearable technology, and it was apparent
that whilst the participants considered the technology as being beneficial to patients, they still had concerns for its use.
Keywords
Wearable technology, biometric monitoring, healthcare, qualitative
Received 25 June 2018; accepted 28 March 2019
Introduction
Wearables can be attached to an individual using a
wristband made of functional textiles, or embedded
microsystems.1One mainstream wearable is the activity
tracker, such as Fitbit, Jawbone and Misfit, which
transforms bouts of movement and physical activity
into quantitative, measurable data, changing the way
in which users understand their own patterns of daily
living.2Feedback gained from technology has the abil-
ity to motivate individuals to change their behaviour.3
It is being increasingly recognised that wearable
technology has the potential to transform healthcare,
providing care that is distinct from usual medical
practice and health delivery.4Innovative wearable tech-
nology has the potential to reduce healthcare costs and
the pressures faced by frontline healthcare staff,5partly
as the result of increased self-care and prevention,
increasing individuals’ control of their own health5.
Particularly, changes to the patient–doctor relationshipis cited as being a primarily positive change based on
the use of wearables.6
Three critical elements of adoption and use have
been considered in creating adoption and long-term
engagement with wearable technology: habit forma-
tion, social motivation and goal reinforcement.2,7
However, despite some theoretical consideration of
what factors are necessary for the long-term adoption
of these technologies, there is currently no evidenceexamining health professionals’ views of individuals
1Department of Psychology, School of Social Sciences, Humanities and Law,
Teesside University, UK
2Department of Nursing, Midwifery and Health, Faculty of Health and Life
Sciences, Northumbria University, UK
Corresponding author:
Gemma Wilson, Department of Nursing, Midwifery and Health, Faculty of
Health and Life Sciences, Northumbria University, Coach Lane Campus,
Newcastle-upon-Tyne, NE7 7XA.
Email: [anonimizat] Health
Volume 5: 1–6!The Author(s) 2019
DOI: 10.1177/2055207619845544
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using these technologies. Most of the studies currently
exploring the use of wearables in healthcare focus
on patient perceptions, some on carers, but few on
health professionals’ views.8–10One study explored all
three, based on the views of general wearables and a
clinically developed wearable used for seizure detec-tion.
9Whilst automatic data showing seizure detection
during consultation was preferred to non-digital meth-
ods, they were worried about increased workload and
confidentiality of data, as well as wearability of users.9
Whilst much focus of this literature currently rests
with the user’s experiences, there is currently little
exploration of health professionals’ views recommend-ing digital technologies to patients. This study aimed to
explore health professionals’ attitudes toward their
patients’ use of wearable technologies.
Methods
Design
A qualitative method was employed in which semi-
structured interviews were utilised to examine the
research aim.
Participants
A convenience sample of health professionals wererecruited to participate in this study. Fliers were sentto general practitioner (GP) surgeries and other health
professionals, and personal contacts were informed of
the study. Individuals were ineligible to participate
only if they were not a practising health professional.A total of 12 health professionals participated inthis study, and took part in semi-structured interviews
(see Table 1 ).
The sample consisted of 12 health professionals;
four GPs, three junior doctors, one dietician, one per-
sonal trainer/pharmaceutical technician, one consul-tant nurse, one occupational therapist and onephysiotherapist (six males, six females; aged 23–61
years). Only two of the health professionals had previ-
ous personal experience using their own wearable tech-nology, but neither used it every day: one participantused an activity tracker whilst running, and one partic-
ipant used wearable technology whilst skiing.
Ethical approval
This study received ethical approval from Teesside
University’s ethical review committee.
Procedure
The lead researcher (AW) provided individuals withboth verbal and written information about the study,
including its purpose and details of their participation.
Once individuals had been given this information, had
Table 1. Participant characteristics.
Participant number Role Sex Age LocationPrevious experience of
wearable technology
P001 GP F 49 Edinburgh None
P002 GP M 41 Edinburgh None
P003 Junior doctor M 24 Glasgow None
P004 GP M 45 Edinburgh NoneP005 Retired GP F Unknown Edinburgh None
P006 GP M 64 Middlesbrough Activity tracker
P007 Junior doctor F 25 Glasgow NoneP008 Personal trainer F 46 Edinburgh Activity tracker
P009 Senior nurse F 53 Edinburgh None
P010 Junior doctor M 23 Glasgow Activity trackerP011 Physiotherapist M 24 Dundee Activity tracker
P012 Occupational therapist F 27 Glasgow None2 DIGITAL HEALTH

the opportunity to answer any questions, and had pro-
vided written consent, an appropriate time wasarranged to participate in a semi-structured interview.One-to-one semi-structured interviews were either car-
ried out face-to-face, over the telephone, or by using
teleconference facilities ensuring that data collectionwas convenient for the participants involved and wid-ened the locality of participants throughout the UnitedKingdom (UK). Before the interview began, an examplewas provided to confirm participants’ understanding ofwearable technology (GoBe, HealBe technology
TM);
however, it was stressed that these were only some exam-
ples of wearable technology, and all forms of wearable
technology were of importance. AW carried out allsemi-structured interviews (each lasting between30 and 60 min) utilising an interview schedule that wasinformed by relevant literature (see Figure 1 ). All semi-
structured interviews were recorded using a Dictaphonerecording device and AW transcribed verbatim.Audacity
VRsoftware was used to abstract data.
Data analysis
Data were analysed using inductive Thematic Analysis.Inductive Thematic Analysis aims to extract patterns ofdata into themes and sub-themes, as they arise from thedata.
11The six steps of conducting Thematic Analysis
were followed, in that the data analyst (AW) familiar-
ised themselves with the data by transcribing andre-reading the data before generating initial codes,searching for themes, reviewing themes, defining andnaming themes, before finally producing the report.
In order to increase methodological rigour, data anal-
ysis was discussed with KS, and themes were checked
to ensure they remained representative of the data.
Results
Four themes emerged from the qualitative findingsrepresenting health professionals’ attitudes towards
patient us of wearable technology, and their percep-
tions of implications that this can have on the
healthcare service and doctor-patient relationship:
‘opportunities for wearable technology’, ‘usability and
understanding’, ‘privacy and surveillance’ and ‘cost’.
Whilst the first theme describes the positive aspects
that wearable technology can have for individuals,
the findings illustrate primarily negative opinions, and
the final three themes demonstrate this.
Opportunities for wearable technology and patient
self-management
It was clear that some participants generally felt that
patients do not take enough responsibility of their
own health and ‘ rely on everyone to sort out the
problem’ (P007).
‘Having a doctor tell you that everything’s looking ok,
that’s an easy way out, it’s not up to us, it’s up to you,
I think that’s a very negative thing.’ (P002).
Definitions were provided throughout, and follow-up exploratory questions were asked
throughout.
Would you say you are generally ‘technologically savvy’?
Do you monitor your own health, if so, what devices do you use?
Do you see any advantages/disadvantages to using biometric feedback, generally?
Would you say as a health professional any advantages/disadvantages for you in
your job by tracking biometrics?
Have you heard anything in your field about wearable computing devices being
used?
If you think wearables could be useful, what kind of biometrics would you like to
be see being used?
How do you feel about prescribing wearable devices to individuals?
Have any of your patients discussed devices they use, and asked you about the
readings or outputs that they have gained?
Have they asked for any kind of advice regarding buying or wearing these
devices? How do you feel about this?
How do you envision wearables impacting your job if they continue on the path
they are projected to follow?
Would you like to see a future with more wearables and people being able to refer
themselves to hospital or surgery using their own info from their wearables?
Could you see any potential disadvantages of wearable technology in the future? If
so, what are these?
Do you think the NHS/ Government should be investing in this area?
Figure 1. Interview schedule.Watt et al. 3

There is a sense that health professionals within the
sample believe that the public are responsible for look-
ing after themselves and think that they are requiredonly for serious health issues. However, all participants
agreed that wearable technologies are a useful tool to
promote self-management, enable others to ‘ take
responsibility of their own health’ (P007) and ‘ be more
aware of themselves’ (P006).
Usability and understanding
Participants described the importance of usability and of
understanding the data recorded by wearable devices.The health professionals had some concerns that some
users may not wear the devices due to aesthetics and
usability. Namely, there were assumptions that female
users may not wear the devices when ‘ dressed up’ (P008)
or‘ o nan i g h to u t ’ (P009) if the device was not hidden.
Furthermore, participants described usability issues as a
potential barrier for use with older adults.
‘I think that, yeah it’s too technical [for older
adults]’ (P008).
‘Even those who are used to smartphone use could see it
being too complicated’ (P008).
However, there was recognition that future generations
of older adults will be more au fait with this technology.
‘when they go back they didn’t have anything like
iPhones or watches or that, whereas, when we are in
our eighties we will, so we will be familiar with those
things, when our generation get dementia I think stuff
like that will be really helpful’ (P012).
Evidently, there were judgements as to who may not
use these devices due to usability or aesthetics.
Usability issues were also of concern, not for the
device itself, but for understanding data provided by
the technology, and participants felt that patients mayunnecessarily worry about their health either due to
data being ‘ misread’ (P010) or by patients over moni-
toring the data.
‘I don’t know how effective they would be because you
can over monitor, people can become, they think they areunwell when they aren’t’ (P011).
One participant was anxious that constant monitoring
of one’s health may ‘ make people more unwell’ (P001).
Instead, it was suggested that wearable devices in which
data ‘ went straight to a health professional’ (P011)
would be more useful. Furthermore, wearable devices
are only able to provide some data, which in isolation,may not be enough ‘ to give the full picture’ (P006)
about their overall health.
Participants showed concern that patients may
worry more about their health due to constant moni-toring, trying to make sense of the data presented tothem, or misinterpreting the findings. In essence, thereseems to be a need for user education, knowledge andunderstanding of the devices.
Privacy and surveillance
Privacy is a much-debated aspect of technology use.The importance of suitable and reliable measures inplace for individual’s health information is of upmostimportance, especially when being used with relation tohealthcare services.
‘I don’t know, I suppose it’s kinda ethically, is acceptable
to constantly know what someone’s health biometricsare’(P011).
Participants referred to wearable technology as ‘a silent
data gathering thing’ (P003) and as ‘ big brother’ (P012).
Ethical as well as privacy concerns are going to need to
be certified and new laws are going to be required.‘Privacy, sharing of the information, that sort of thing,would be, all that would have to be clarified’ (P004).
Concerns of privacy are of obvious worry to partici-
pants and are further compounded by both researchand policy lagging behind continuously emerging andchanging invocations.
Cost
The ability to save money is a huge concern for theNational Health Service (NHS) and for those thatwork within it. Participants discussed both the poten-tial long-term cost savings to healthcare systems due toincreased autonomy, self-management of long-termconditions, and improved preventative behaviours.
‘if you can prevent a fall happening, each operation costs
£10,000 pounds so if you can prevent an operation hap-pening, you’re saving the NHS a lot of money’ (P011).
‘You’d save the NHS a lot of money. I think that is a big
question, yeah, I think there are things you can do, and
most of them are to do with motivation’ (P010).
However, whilst some considered long-term cost saving
to the NHS to be a result of reduced emergency admis-sion to hospital and improved methods of self-management, some also discussed the barriers to4 DIGITAL HEALTH

providing patients with these devices over traditional
treatments, such as drugs.
‘I suppose the issue for the NHS is the cost for these
things’ (P011).
There were two ways of considering cost of wearable
devices: as potentially saving NHS funds in the long-
term, but also the short-term cost of the actual devices.
Discussion
This study aimed to explore health professionals’ atti-tudes toward patients’ use of wearable technologies.Four themes were generated from the interview data
collected: opportunities for wearable technology,
usability and understanding, privacy and surveillanceand cost. The themes illustrate the ambivalent views ofhealth professionals involved in this study, and it was
apparent that whilst the participants considered the
technology as being beneficial to patients, they stillhad concerns for its use. The health professionalsunderstood there was a use for wearables but could
see a number of limitations that would require to be
rectified before mass adoption.
An unexpected discovery from the current study was
the realization that those health professionals inter-viewed did not think the NHS was adequately provid-ing preventive care to avoid illness or disease. Most
interviewees agree that the NHS was instrumental at
administering life-threatening interventions and ongo-ing chronic cases; however, they stressed that consulta-tion time was taken up as a result of the lack of focus of
preventative care and the self-management of long-
term conditions in the NHS. Similar to the developinghealth policy in the UK,
5health professionals felt that
wearable technologies could be used as tools to
improve illness and disease prevention, and the self-management of long-term conditions.
Barriers to use included gendered and age-related
perceptions of aesthetic design, usability and interpreta-tion, which were discussed. All of which have been con-
sidered in previous research primarily by the user’s own
perspective but also by the perspective of health profes-sionals.
9The aesthetics of technology are important,
and are considered in general models of technology
use and user experience and empirical research which
evidence the importance of wearability,12including aes-
thetics and comfort.13–16Interestingly, within this study,
health professionals’ perceptions of the importance of
aesthetics impact their recommendation of wearable
technology to patients. Furthermore, it is apparentthat the health professionals in this study consider ageto be a barrier. Although it is important to consider age-
related aspects of technology design and usability suchas sensory, motor and cognitive functioning,
17,18evi-
dence has demonstrated many pieces of wearable tech-
nology as being suitable for use, and enjoyed, by older
adults.19,20Some studies focusing on older adults’ expe-
riences of wearable technology, show that preconcep-
tions make individuals more wary of the technology,19
often with older adults considering it to be designed for
younger people.21However, interestingly, older adults
within one study specifically stated that promotion of
these wearable devices by health professionals would
make them more likely to use them.21
Wearables relating to healthcare must be consid-
ered with high privacy concerns,22and this was clear-
ly an important consideration for participants in this
study, reflecting previous research.9Data protection
concern has been growing but an area of heated
debate is in the medical sphere. This is also an area
of considerable concern for the NHS, and is a central
point of its digital innovation plans, to ensure ‘ every
citizen’s data is protected ’.23Furthermore, cost was a
concern, and participants not only considered the
cost savings but also the cost and sustainability of
these devices within NHS budget.
This study presents some limitations. Primarily, the
sample size was small and consisted of health profes-
sionals primarily from one region. Differing usage and
experiences may be observed with different groups of
health professionals and cultural factors may also play
a role. Furthermore, the researcher had previous per-
sonal connections with some participants, which may
have impacted their participation and response. Thestudy remit was broad, including any wearable technol-
ogy, and, accordingly, exploring the use of specific
wearable technologies may be informative. Future
research must build on these findings and provide a
more comprehensive evidence base in this area, as
policy is promoting the uptake of wearable use for pre-
vention and self-management; however, the importance
of adopting wearable technologies also lies with health
professionals.
Contributorship:
AW carried out this work as part of his MSc
Health Psychology qualification. AW researched the litera-ture and conceived the project, carried out data collection,and analysed the data. KS supervised this work. All authors
wrote the paper. KS and GW edited the paper. All authors
reviewed and approved the final version of the manuscript.
Declaration of conflicting interests: The author(s) declared
no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
Ethical approval: The ethics committee of Teesside University’s
ethical review committee.Watt et al. 5

Funding: The author(s) received no financial support for the
research, authorship, and/or publication of this article.
Guarantor: GW
ORCID iD
Gemma Wilson https://orcid.org/0000-0001-7362-7048
Peer review: This manuscript was reviewed by two individ-
uals who have chosen to remain anonymous.
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