Factors associated with long-term use of digital devices in the electronic Framingham Heart Study

Abstract

Long-term use of digital devices is critical for successful clinical or research use, but digital health studies are challenged by a rapid drop-off in participation. A nested e-cohort (eFHS) is embedded in the Framingham Heart Study and uses three system components: a new smartphone app, a digital blood pressure (BP) cuff, and a smartwatch. This study aims to identify factors associated with the use of individual eFHS system components over 1-year. Among 1948 eFHS enrollees, we examine participants who returned surveys within 90 days (n = 1918), and those who chose to use the smartwatch (n = 1243) and BP cuff (n = 1115). For each component, we investigate the same set of candidate predictors for usage and use generalized linear mixed models to select predictors (P < 0.1, P value from Z test statistic), adjusting for age, sex, and time (app use: 3-month period, device use: weekly). A multivariable model with the predictors selected from initial testing is used to identify factors associated with use of components (P < 0.05, P value from Z test statistic) adjusting for age, sex, and time. In multivariable models, older age is associated with higher use of all system components. Female sex and higher education levels are associated with higher completion of app-based surveys whereas higher scores for depressive symptoms, and lower than excellent self-rated health are associated with lower use of the smartwatch over the 12-month follow-up. Our findings show that sociodemographic and health related factors are significantly associated with long-term use of digital devices. Future research is needed to test interventional strategies focusing on these factors to evaluate improvement in long-term engagement.

Characteristics and Attitudes of Wearable Device Users and Nonusers in a Large Health Care System

“…Third, most individuals included were White, and there was minimal representation of Hispanic individuals. Although the absolute number of individuals in our study from racial minority groups compares favorably to prior studies of wearable technology, 6 , 7 our findings may not generalize to populations with varying racial and ethnic composition. Fourth, we studied a sample of longitudinal primary care and cardiology patients having a specific comorbidity profile that may differ from other populations.…”

“…A recent analysis of ≈2000 individuals from the Framingham research cohort found that age, sex, and educational attainment were each associated with digital health engagement. 6 A second survey‐based study including just >1200 respondents reported that patients with atrial fibrillation were more likely to share wearable device data with their health care providers. 7 A nationally representative survey relying solely on self‐reported data found that an estimated 29% of individuals use wearable devices, and that those with cardiovascular conditions had a lower prevalence of device use.…”

“…Although greater availability of consumer wearable devices has potential to improve public health, there are concerns about collection of physiologic data in individuals unlikely to have disease (ie, young and healthy), as well as potential exacerbation of existing health care disparities on the basis of factors such as sociodemographic status or presence of disease. Although large population‐based studies have provided insight into socioeconomic and demographic patterns of consumer wearable device use, 2 , 6 , 7 , 8 , 9 , 10 these survey‐based platforms have lacked the ability to integrate comprehensive individual‐level clinical data. 2 , 6 , 7 , 8 Large pragmatic clinical studies assessing the validity of wearable technology, such as the Apple Heart Study 11 and Fitbit Heart Study, 12 have similar limitations.…”

“…Although large population‐based studies have provided insight into socioeconomic and demographic patterns of consumer wearable device use, 2 , 6 , 7 , 8 , 9 , 10 these survey‐based platforms have lacked the ability to integrate comprehensive individual‐level clinical data. 2 , 6 , 7 , 8 Large pragmatic clinical studies assessing the validity of wearable technology, such as the Apple Heart Study 11 and Fitbit Heart Study, 12 have similar limitations. Even smaller investigations of consumer wearable device use in relation to disease‐specific outcomes, including peripheral arterial disease, 13 obesity, 14 , 15 chronic obstructive pulmonary disease, 16 insomnia, 17 and stroke, 18 typically rely on patient‐reported health indices rather than primary data from the electronic health record (EHR).…”

Depressive symptoms are not associated with clinically important levels of digital home blood pressure in the electronic Framingham Heart Study

“… 52 Higher depressive symptoms have been associated with lower engagement with digital device use. 53 , 54 Targeted interventional strategies to support digital device use may result in improvement in regular and longer-term self-home BP management in this group. Interventions could also address disparities in age, educational attainment, and household income, which are known to be associated with lower wearable device use.…”