Using Smartphones and Wearable Devices to Monitor Behavioral Changes During COVID-19

Abstract

Background In the absence of a vaccine or effective treatment for COVID-19, countries have adopted nonpharmaceutical interventions (NPIs) such as social distancing and full lockdown. An objective and quantitative means of passively monitoring the impact and response of these interventions at a local level is needed. Objective We aim to explore the utility of the recently developed open-source mobile health platform Remote Assessment of Disease and Relapse (RADAR)–base as a toolbox to rapidly test the effect and response to NPIs intended to limit the spread of COVID-19. Methods We analyzed data extracted from smartphone and wearable devices, and managed by the RADAR-base from 1062 participants recruited in Italy, Spain, Denmark, the United Kingdom, and the Netherlands. We derived nine features on a daily basis including time spent at home, maximum distance travelled from home, the maximum number of Bluetooth-enabled nearby devices (as a proxy for physical distancing), step count, average heart rate, sleep duration, bedtime, phone unlock duration, and social app use duration. We performed Kruskal-Wallis tests followed by post hoc Dunn tests to assess differences in these features among baseline, prelockdown, and during lockdown periods. We also studied behavioral differences by age, gender, BMI, and educational background. Results We were able to quantify expected changes in time spent at home, distance travelled, and the number of nearby Bluetooth-enabled devices between prelockdown and during lockdown periods (P<.001 for all five countries). We saw reduced sociality as measured through mobility features and increased virtual sociality through phone use. People were more active on their phones (P<.001 for Italy, Spain, and the United Kingdom), spending more time using social media apps (P<.001 for Italy, Spain, the United Kingdom, and the Netherlands), particularly around major news events. Furthermore, participants had a lower heart rate (P<.001 for Italy and Spain; P=.02 for Denmark), went to bed later (P<.001 for Italy, Spain, the United Kingdom, and the Netherlands), and slept more (P<.001 for Italy, Spain, and the United Kingdom). We also found that young people had longer homestay than older people during the lockdown and fewer daily steps. Although there was no significant difference between the high and low BMI groups in time spent at home, the low BMI group walked more. Conclusions RADAR-base, a freely deployable data collection platform leveraging data from wearables and mobile technologies, can be used to rapidly quantify and provide a holistic view of behavioral changes in response to public health interventions as a result of infectious outbreaks such as COVID-19. RADAR-base may be a viable approach to implementing an early warning system for passively assessing the local compliance to interventions in epidemics and pandemics, and could help countries ease out of lockdown.

Non-pharmaceutical interventions during the COVID-19 pandemic: A review

“…Age and gender groups behaved similarly, reporting a consistent relative variation respect to pre lockdown period. Reduction of steps and increase homestay have been reported also outside Germany [248] . Furthermore, use of phone and social media apps have increased.…”

“…Though the aim will be the same, what changes is the methodology used to characterize changes in mobility. Here, we report two studies done with cohort of individuals in Germany [247] and more than people in five European countries [248] . In both cases, smartphone apps were used to collected information about mobility (distance travelled, steps count) as well as other indicators (heart rate, sleep duration, bedtime, social app use).…”

Social relationships and depression during the COVID-19 lockdown: longitudinal analysis of the COVID-19 Social Study

“…The experience of social relationships changed during the COVID-19 pandemic. People turned to remote methods of communication, with increased use of phone calls – for example average call duration increased from 3.7 to 5.4 min from January to April 2020 in the UK (Ofcom, 2020 ) – and higher use of mobile messaging and video-calling in the UK and throughout Europe (Sun et al, 2020 ). It is important to consider whether these approaches to maintain relationships were associated with better mental health, as this may guide policy to reduce the impact of future periods of lockdown during COVID-19 and other pandemics.…”

Attitudes Toward Using COVID-19 mHealth Tools Among Adults With Chronic Health Conditions: Secondary Data Analysis of the COVID-19 Impact Survey

“…Among the apps that allow for real-time symptom monitoring, trackers and telemedicine systems have helped elucidate the frequency of symptoms associated with COVID-19, thereby allowing patients and health care providers the opportunity to respond early to symptom progression [ 44 , 47 , 48 , 66 ]. Reviews of contact tracing apps have highlighted their effectiveness in improving the spatiotemporal reporting of new cases, management and follow-up of COVID-19 cases, and education on preventive behaviors [ 52 , 53 , 57 , 58 , 67 - 70 ]. To address the mental and social impacts of the COVID-19 pandemic, several apps have focused on reducing social isolation, providing positive coping strategies, and monitoring mental health symptoms [ 55 , 56 , 63 , 71 - 74 ].…”