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

Abstract

Background: The family environment plays a crucial role in child physical activity (PA). Wearable activity trackers (wearables) show potential for increasing children’s PA; however, few studies have explored families’ acceptance of wearables. This study investigated the acceptability of using wearables in a family setting, aligning experiences with components of the Technology Acceptance Model and Theoretical Domains Framework. Methods: Twenty-four families, with children aged 5–9 years, took part in a 5-week study, where all members were provided with a Fitbit Alta HR for 4 weeks. Acceptability was measured using weekly surveys and pre-post-questionnaires. Nineteen families participated in a focus group. Quantitative and qualitative data were integrated using the Pillar Integration Process technique. Results: Pillars reflected (1) external variables impacting wearable use and PA and (2) wearable use, (3) ease of use, (4) usefulness for increasing PA and other health outcomes, (5) attitudes, and (6) intention to use a wearable, including future intervention suggestions. Conclusions: Families found the Fitbit easy to use and acceptable, but use varied, and perceived impact on PA were mixed, with external variables contributing towards this. This study provides insights into how wearables may be integrated into family-based PA interventions and highlights barriers and facilitators of family wearable use.

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

“…Previous research has similarly found that parental screen use is associated with child screen use, with parental attitudes towards screen use also having an impact (Lauricella et al 2015). A recent study found that providing parents and children with a wearable can increase awareness of PA levels and promote PA via competition (Creaser et al 2022), with another study finding wearables can prompt families to discuss health with one another (Sharaievska et al 2019). Therefore, parent wearable use (current or previous) impacts child/adolescent wearable use, and this co-use of wearables may be beneficial, such as adopting healthier lifestyles (Creaser et al 2022) and increasing conversations about health (Sharaievska et al 2019).…”

“…The survey consisted of between 19 and 23 items (including demographic questions), depending on whether the child; (1) currently (n = 21), (2) previously (but no longer) (n = 23), or (3) had never (n = 19) used a wearable. Questions were developed based on previous research using the same theoretical underpinnings (TDF, COM-B model) (Creaser et al 2022;Eddy et al 2021), and were derived based on the recommendations and terminology outlined by Michie et al (2015) (e.g. using examples from the 'COM-B self-evaluation questionnaire'; Michie et al 2015) The face validity of the survey items was evaluated by a multi-disciplinary team (n = 5), who provided critical insights into the appropriateness of the items, compared to the definitions outlined by Michie et al (2015).…”

“…Owing to the cross-sectional nature of this study, cause and effect cannot be determined, and it is unclear whether such knowledge was a result of using a wearable. However, previous research has found that wearables are limited in their ability to improve parent's understanding of child PA recommendations (Creaser et al 2022), but it is unclear how this translates to child/adolescent knowledge and how these results may have been mediated by other socio-economic factors. Unsurprisingly, children who understood what a wearable was were more likely to currently use or have previously used a wearable, than have never used a wearable (but this was not found in adolescents).…”

“…A recent study found that providing parents and children with a wearable can increase awareness of PA levels and promote PA via competition (Creaser et al 2022), with another study finding wearables can prompt families to discuss health with one another (Sharaievska et al 2019). Therefore, parent wearable use (current or previous) impacts child/adolescent wearable use, and this co-use of wearables may be beneficial, such as adopting healthier lifestyles (Creaser et al 2022) and increasing conversations about health (Sharaievska et al 2019). Thus, providing both parents and their children with wearables may be a useful intervention strategy in future work (Creaser et al 2022).…”

“…The TDF is a comprehensive framework consisting of 14 domains, derived from 33 psychological theories of behaviour change, which align with components of the COM-B model (Atkins et al 2017). The COM-B model/TDF has previously been used to explore families' acceptance of wearables (Creaser et al 2022), but its use in this study can provide key insights into whether child/ adolescent, or their parents, capability, opportunity and motivation, and its sub-components (TDF), impacts habitual wearable use.…”